Synopsis
Recognise ocular ischaemia from giant-cell arteritis, start time-critical glucocorticoid treatment, and coordinate diagnostic confirmation and safe long-term management.
- Consider giant-cell arteritis in adults over fifty with a new headache, jaw claudication, scalp tenderness or compatible visual symptoms.
- Ocular disease may occur without a prominent headache or the complete systemic symptom pattern.
- Obtain inflammatory markers and blood counts promptly when feasible, but treatment must not wait for results when clinical suspicion is strong.
Key red flags
Suspected giant-cell arteritis with new visual loss or diplopia needs same-day ophthalmic assessment and immediate glucocorticoid treatment.
Investigation priorities
Determine whether ocular ischaemia is present and protect remaining vision.
Management branches
GCA is suspected and the patient has new persistent or transient visual ischaemic symptoms.
- Start glucocorticoids immediately and arrange ophthalmology as soon as possible on the same calendar day with urgent medical or rheumatology coordination.
- For acute or intermittent visual loss, consider the BSR intravenous methylprednisolone regimen of 500 mg–1 g daily for up to three consecutive days, then oral treatment.
Key medicines
Methylprednisolone for threatened visionBSR conditionally recommends 500 mg–1 g intravenously once daily for up to three consecutive days for acute or intermittent visual loss, followed by oral glucocorticoids.
Prednisolone when intravenous therapy is delayedFor acute or intermittent visual loss when intravenous treatment is not immediately possible, BSR permits 60–100 mg orally once daily for up to three days, then specialist-directed continuation.