Ophthalmic Manifestations of Giant Cell Arteritis.

Abstract

Giant cell arteritis (GCA), also referred to as temporal or Horton’s arteritis, is a vasculitis with both systemic and ophthalmic manifestations. The incidence of GCA in those aged 50 years or older varies based on the geographic location and ranges from 1.1 to 43.6 per 100,000.1 The prevalence of GCA increases with age, is highest in those older than age 70, and is rare in those younger than age 50.1–4 It is more common in White populations, although GCA has been reported in other racial groups.1,5,6 There is a greater incidence of GCA in women compared with men by a ratio of about 3 to 1.1,5,6 The incidence of reported visual complications associated with GCA varies widely and ranges from about 12% to 70%.7–9 Furthermore, about 16% to 26% of patients with visual dysfunction from GCA can follow an occult form, which consists of ophthalmologic signs and symptoms in the absence of systemic symptoms, though in these cases serum erythrocyte sedimentation rate and C-reactive protein are almost always elevated.10,11 Visual symptoms due to GCA represent a neuro-ophthalmologic emergency, and thus warrant expeditious diagnosis and treatment to avoid preventable blindness or permanent visual impairment. This review discusses the ophthalmic manifestations of GCA, which include dysfunction of both the afferent and efferent visual pathways. The vasculitis caused by GCA tends to affect mid-sized and largesized arteries that are extradural and contain elastic lamina. There is a predilection for involvement of the ophthalmic, posterior ciliary, central retinal, vertebral, and superficial temporal arteries.12 Inflammation within the arterial wall causes vessel lumen narrowing, which in turn can lead to thrombosis, vascular occlusion, and tissue ischemia.13 The vasculitis from GCA can cause ischemia of the optic nerve, retina, ocular