11.3 Giant Cell Arteritis- Visually Asymptomatic

eyes.nhs.scot/
Eyecare Guidelines/
Section 11 - Optic Nerve/
11.3 Giant Cell Arteritis- Visually Asymptomatic

Date of last review: Due to be updated

Differential diagnosis

Migraine
Analgesic induced headache
Cluster headache
Trigeminal neuralgia

Possible management by Optometrist

Treatment

None

Advice

Urgent referral to the GP same day
Advice to General Practice

Measure CRP (ESR if CRP 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

GP to commence oral steroids and refer to hospital for temporal artery ultrasound or biopsy (may not be performed by ophthalmology department if no visual symptoms: check protocol with local hospital)
If same day GP review not possible, refer urgently to ophthalmology or rheumatology, according to local guidelines.

Management Category

Urgent referral to GP
Urgent referral to ophthalmology or rheumatology, according to local guidelines

Possible management by Ophthalmologist

Steroids (with gastric protection)
Temporal artery ultrasound or biopsy to confirm the diagnosis

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