Ischemic Optic Neuropathy from Giant Cell Arteritis

Giant cell arteritis (GCA) is a challenging condition to manage. Patients presenting with ION warrant special consideration, because their vision loss is often irreversible. In general terms, the neuroophthalmic care of these patients is governed by several universal goals, namely: preserving or improving the visual status of the patient; protecting the patient from non-visual consequences of the diagnosis; and, ameliorating the inevitable effects of high-dose, long term corticosteroid therapy. Yet, for any given patient there are also challenges that are case specific. Clinicians caring for these individuals must consider the relative frailty of the patient, and anticipate what co-morbidities may be unveiled or exacerbated by treatment. Moreover, the severity of the patient's vision loss, and presence or absence of non-visual manifestations also impact management decisions.