In any patient over 50 with anterior ischaemic optic neuropathy, giant cell arteritis must be considered at the first visit. Jaw claudication, scalp tenderness, new headache, weight loss and polymyalgia symptoms raise suspicion; a chalky-white swollen disc and choroidal hypoperfusion favour arteritis.
ESR, CRP and platelet count should be sent the same day, and steroids should not wait for biopsy or imaging when suspicion is high, because the second eye can be lost within days. Biopsy remains informative for at least one to two weeks after steroids start.
- Ask about jaw claudication, scalp tenderness, headache and polymyalgia symptoms in every ischaemic optic neuropathy over 50.
- Send ESR, CRP and platelets on the day of presentation.
- Start high-dose steroids without waiting for biopsy when suspicion is high.
- Arrange temporal artery biopsy or vascular ultrasound within the first one to two weeks of treatment.
Why it matters
The second eye is what is at stake while the workup proceeds.
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