11.1 Anterior Ischaemic Optic Neuropathy, Arteritic (Giant Cell Ateritis)

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Eyecare Guidelines/
Section 11 - Optic Nerve/
11.1 Anterior Ischaemic Optic Neuropathy, Arteritic (Giant Cell Ateritis)

Date of last review: Due to be updated

Differential diagnosis

Diabetic papillopathy
Non Arteritic Anterior Ischaemic Optic Neuropathy
Systemic vasculitis

Possible management by Optometrist

Treatment

None

Advice

Urgent treatment with steroids required
Depending on location, may be quicker to contact GP initially, before attending ophthalmology
Advice to General Practice

Measure CRP (ESR if not possible) and full blood count prior to starting treatment
Start prednisolone

60mg daily one week
45mg daily one week
30mg daily one week
20mg daily one week
15mg daily for one week

Monitor response day 1 or 2 after starting 60mg of prednisolone

Symptoms should have dramatically responded
Inflammatory markers (CRP, ESR (delayed), platelets should have significantly improved
Thereafter monitor response by symptoms and inflammatory markers every few months until after treatment ends

If no, or poor response, reconsider diagnosis
Reconsider management next when patient down to 15mg daily
If there has been a rapid improvement in symptoms and inflammatory markers, then reduce prednisolone to

12.5 mg daily for one week
then 10mg daily for one month
Reduce prednisolone thereafter by 1mg a month to 5mg daily.
Stay on 5mg daily until anniversary
Then reduce by 1mg a month to zero

If the response has been slower then

Reduce prednisolone by 1mg a month to 5mg daily.
Stay on 5mg daily until anniversary
Then reduce by 1mg a month to zero

Prescribe omeprazole 20mg daily until down to less than 10mg of prednisolone
Start on Alendronic Acid with adequate Calcium and Vitamin D supplementation

Management Category

Urgent referral to ophthalmology

Possible management by Ophthalmologist

Steroids (with gastric protection)
Temporal artery biopsy

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