TY - JOUR T1 - Giant Cell Arteritis: Visual Loss Is Our Major Concern JF - The Journal of Rheumatology JO - J Rheumatol SP - 1458 LP - 1461 DO - 10.3899/jrheum.160466 VL - 43 IS - 8 AU - MIGUEL A. GONZALEZ-GAY AU - SANTOS CASTAÑEDA AU - JAVIER LLORCA Y1 - 2016/08/01 UR - http://www.jrheum.org/content/43/8/1458.abstract N2 - Giant cell arteritis (GCA) is the most common vasculitis in Western countries among individuals 50 years and older1. This medium and large-vessel granulomatous vasculitis typically affects the extracranial branches of the carotid artery1. Common features of the disease such as headache or jaw claudication are the result of vasculitic involvement of arteries derived from the external carotid artery. However, visual manifestations, including visual loss — the most feared complications of this vasculitis — are generally due to the arteritic damage affecting the ophthalmic branches of the internal carotid artery2.The most common ophthalmic manifestation of GCA is anterior ischemic optic neuropathy, which is caused by interruption of blood flow in the posterior ciliary arteries to the optic nerve head. The clinical picture is described as sudden painless loss of vision3. Visual loss may present as a mist in all or part of the visual field and evolve within 24 to 48 hours to total blindness. Unilateral visual loss may be initially unnoticed by the patient until, by chance, the unaffected eye is covered. One eye is affected first, but involvement of the other eye in untreated patients may occur 1 to 10 days after the initial event4. In the acute phase of anterior ischemic optic neuropathy, the optic disc is pale and swollen, but the retina is almost normal. Afterward, optic nerve atrophy associated with optic disc cupping is observed. Less commonly, visual loss is caused by central retinal artery occlusion, ischemic retrobulbar neuropathy or occipital infarction in the context of a stroke involving the vertebrobasilar territory2. When the arteritic process involves the central retinal artery leading to retinal stroke, the retina is damaged primarily and it appears greyish and swollen, and a contrasting red zone can be … Address correspondence to Prof. M.A. González-Gay, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, c/ Avenida de Valdecilla s/n, 39008, Santander, Spain. E-mail: miguelaggay{at}hotmail.com ER -