Ophthalmic manifestations of giant cell arteritis

Introduction: Giant cell arteritis (GCA) is an ophthalmic emergency because of its potential for irreversible blindness. Clinicians should be aware of the variable presentations, laboratory features, and evaluation of GCA because earlier diagnosis and treatment can prevent loss of sight. Areas covered: We have provided an update on recent advances in the diagnosis, treatment, and prognosis of GCA. We searched the PubMed database from 1990 to 2023 for relevant reviews, case reports, and trials. Emerging treatments for GCA are additionally summarized. Expert opinion: Clinicians should be aware of common and uncommon presentations of GCA. A high index of suspicion is essential for detection of GCA in elderly patients, and early treatment can prevent or reduce permanent vision loss. GCA is a true ophthalmic emergency and high dose empiric glucocorticoid treatment is recommended followed by confirmation with temporal artery ultrasound and/or biopsy. New vascular imaging methods and approaches to acute and maintenance therapy for GCA have emerged over the past several years. Temporal artery ultrasound shows increasing sensitivity and specificity and may eventually replace ‘gold standard’ histopathologic confirmation by temporal artery biopsy. Emerging steroid-sparing therapies like tocilizumab may reduce prednisone dosages and induce long-term remission with less systemic adverse effects.