Vision Loss From Giant Cell Arteritis in Patients With Other Ocular Diagnoses

Vision problems from giant cell arteritis (GCA) can be difficult to diagnose as patients may present with vision loss in the absence of systemic symptoms, have other comorbidities that affect inflammatory blood markers, or have other ocular diagnoses. We present 3 cases illustrating this point including a patient with advanced glaucoma with worsening vision from posterior ischemic optic neuropathy from GCA, a patient with arteritic anterior ischemic optic neuropathy (AAION) erroneously diagnosed as optic neuritis without elevated inflammatory blood markers due to corticosteroid use, and a patient with AAION and a history of nonarteritic anterior ischemic optic neuropathy in her fellow eye and untreated obstructive sleep apnea. GCA should be kept in the differential diagnosis for patients over 50 years of age even if they carry other ocular diagnoses. Temporal artery biopsy remains the gold standard for GCA diagnosis and is often required in equivocal cases. (C) 2020 by North American Neuro-Ophthalmology Society