[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Ocular emergencies and trauma](https://durgical.com/en/ophthalmology/areas/emergencies/) › Giant cell arteritis and the eye: treat before the biopsy # Giant cell arteritis and the eye: treat before the biopsy - Emergency Giant cell arteritis can cut the optic nerve's blood supply and blind one eye, then the other. Corticosteroids start the same day, before the biopsy. Updated Nov 5, 2026 **See it in 3D:** [Optic disc](https://durgical.com/en/anatomy/optic-disc/) · [Optic nerve](https://durgical.com/en/anatomy/optic-nerve/) · [Ophthalmic artery](https://durgical.com/en/anatomy/ophthalmic-artery/) ## Key points - Over 50 + sudden visual loss: think giant cell arteritis. - Chalky white swollen disc + high ESR and CRP. - Steroids now; biopsy later (within one to two weeks). - Untreated, the other eye follows within days. ## What it is Arteritic anterior ischaemic optic neuropathy is the main cause of blindness in giant cell arteritis, a vasculitis of medium and large arteries in people over 50. The posterior ciliary arteries close, and the optic nerve head infarcts: vision is lost suddenly and the disc is pale and swollen. Without treatment the other eye is often affected within days. The non-arteritic form, much more common, affects a small crowded disc and has no proven treatment. ## How to recognise it - Over 50 with new headache, scalp tenderness, jaw pain on chewing, fever, weight loss or shoulder and hip stiffness. - Transient visual loss or double vision in the days before. - Sudden severe visual loss with a chalky white swollen disc. - Very high ESR and CRP, often with a high platelet count. - Visual loss in one eye: the other eye is at risk within days. ## What to do at once - In any patient over 50 with sudden visual loss, ask the symptoms of giant cell arteritis. - Feel the temporal arteries: thickened, tender or pulseless. - Order ESR, CRP and a blood count the same day. - Start high-dose corticosteroids at once if the diagnosis is suspected; with visual loss, intravenous treatment is often used. - Arrange temporal artery ultrasound or biopsy within one to two weeks; the biopsy stays positive after steroids are started. - Refer to ophthalmology and rheumatology. ## Mistakes that cost sight - Waiting for the biopsy before treating risks blindness in the other eye. - Non-arteritic ischaemic optic neuropathy happens in a small disc with no cup, with hypertension, diabetes or sleep apnoea, and with normal ESR and CRP. - Vision lost from arteritic optic neuropathy rarely recovers; the aim of treatment is to protect the other eye. ## Next step / Initial management - Suspected giant cell arteritis with visual symptoms: corticosteroids the same day and emergency referral. - Confirm with temporal artery ultrasound (halo sign) or biopsy, without delaying treatment. - Long tapering steroid course under rheumatology, with bone protection; steroid-sparing drugs in selected patients. - Non-arteritic form: control vascular risk factors, assess for sleep apnoea, and follow up with ophthalmology. ## Test yourself Think of the answer, then tap the question to see it. ## When should corticosteroids be started in suspected giant cell arteritis with visual loss? The same day, as soon as the diagnosis is suspected, without waiting for the biopsy. ## Why can treatment start before the temporal artery biopsy? Because the biopsy remains diagnostic for one to two weeks after starting corticosteroids. ## How does the non-arteritic form differ? It is more common, affects a small crowded disc, has normal ESR and CRP and no proven treatment. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/giant-cell-arteritis-and-the-eye-treat-before-the-biopsy/) ## Connections ## See it in 3D 3 The structures of Durgical's 3D anatomy where it is found. - [Optic disc](https://durgical.com/en/anatomy/optic-disc/) - [Optic nerve](https://durgical.com/en/anatomy/optic-nerve/) - [Ophthalmic artery](https://durgical.com/en/anatomy/ophthalmic-artery/) ## Related 4 - [Sudden painless visual loss](https://durgical.com/en/ophthalmology/sudden-painless-visual-loss/) - [Central retinal artery occlusion: an eye stroke](https://durgical.com/en/ophthalmology/central-retinal-artery-occlusion-an-eye-stroke/) - [The swollen optic disc: papilloedema or not](https://durgical.com/en/ophthalmology/the-swollen-optic-disc-papilloedema-or-not/) - [Transient visual loss (amaurosis fugax)](https://durgical.com/en/ophthalmology/transient-visual-loss/) ## Related conditions 3 - [Giant cell arteritis](https://durgical.com/en/conditions/giant-cell-arteritis/) - [Central retinal artery occlusion](https://durgical.com/en/conditions/central-retinal-artery-occlusion/) - [Takayasu arteritis](https://durgical.com/en/conditions/takayasu-arteritis/) ## In Pharmacology 2 - [Methylprednisolone](https://durgical.com/en/pharmacology/methylprednisolone/) - [Prednisone](https://durgical.com/en/pharmacology/prednisone/) [← All of ophthalmology](https://durgical.com/en/ophthalmology/) Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once. Sources: [Giant Cell Arteritis (Temporal Arteritis)](https://www.ncbi.nlm.nih.gov/books/NBK459376/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Nonarteritic Anterior Ischemic Optic Neuropathy](https://www.ncbi.nlm.nih.gov/books/NBK559045/) (StatPearls Publishing (NCBI Bookshelf), 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/ophthalmology/giant-cell-arteritis-and-the-eye-treat-before-the-biopsy/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/giant-cell-arteritis-and-the-eye-treat-before-the-biopsy/