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Sudden loss of vision is an ophthalmological emergency and requires immediate
referral to the eye emergency department.
- giant cell arteritis is
treated with 40-60 mg per day of prednisolone in the absence of ocular symptoms.
In addition, 75 mg aspirin (if no contra-indications) and a proton pump inhibitor should be started (1,2).
- urgent specialist referral advised – a biopsy of temporal artery should be done ideally within 2 weeks of starting steroid therapy (2).
- if visual symptoms then treatment is with 1mg per kg per day prednisolone
(60-80mg) (1). Intravenous methylprednisolone is sometimes used in cases of impending
- aggressive treatment of these patients is to prevent vision
loss in the contralateral eye, which has 20-50 per cent chance of becoming affected
within a short period of time
- same-day ophthalmologist referral recommended (2)
- steroid treatment is gradually
tapered by 5-10mg every two weeks until reaching 20mg per day and then more slowly
- the effectiveness of treatment is monitored by the patient's ESR.
Treatment should not need to be continued for more than a year
on steroid treatment then other issues such as osteoporosis prevention in the
form of calcium supplements and bisphosphonates needs to be considered. Also regular
monitoring of blood pressure and blood sugar is essential. The clinical team must
maintain a high index of suspicion for infections during courses of high-dose
steroid treatment as this may mask symptoms and signs of infection.
is evidence that adjunctive treatment with methotrexate lowers the risk of relapse
and reduces exposure to corticosteroids (3)
Last reviewed 01/2018