Giant Cell Arteritis

Giant cell arteritis (GCA) in an autoimmune condition causing inflammation of the media of primarily large- and medium-sized arteries. It predominantly occurs in the elderly with increasing incidence with each decade after age 50. There are a number of ophthalmic symptoms including transient or persistent diplopia, transient or persistent vision loss, headache, eye pain, and photophobia. Ophthalmic signs include strabismus, optic disc pallor and edema from ischemic optic neuropathy, cotton wool spots, central retinal artery occlusion, and ocular ischemic syndrome manifesting such as retinal hemorrhages, neovascularization of the retina, angle, and iris, anterior uveitis, corneal edema, hypotony, and neovascular glaucoma. GCA has traditionally been treated with corticosteroids. Tocilizumab was approved in 2017 by the US FDA for treatment of GCA in conjunction with corticosteroids. However, ideal route and dose of corticosteroid initiation, and which patients benefit from the addition of tocilizumab and optimal timing for its initiation, are not well defined.