A medical emergency that can cause permanent blindness
Giant Cell Arteritis (GCA) — Emergency Vision Care in Los Angeles
Giant cell arteritis is one of the few true ophthalmic emergencies. Without immediate treatment, it can cause sudden, permanent, and irreversible blindness. If you are over 50 and experiencing a new severe headache, jaw pain while chewing, or sudden vision loss, seek emergency evaluation immediately. Our Los Angeles neuro-ophthalmology practice provides urgent GCA evaluation.
What is Giant Cell Arteritis (GCA)?
Giant cell arteritis (GCA), also called temporal arteritis, is an inflammatory disease of medium and large blood vessels that predominantly affects people over age 50. It causes inflammation in the walls of the arteries — particularly the temporal arteries and the arteries supplying the optic nerves. When blood flow to the optic nerve is blocked, it results in arteritic anterior ischemic optic neuropathy (A-AION) and irreversible vision loss. GCA is a medical emergency — treatment must begin immediately, even before confirmatory testing, to protect vision in the unaffected eye.
Symptoms of Giant Cell Arteritis (GCA)
- New, severe headache — especially in the temple region
- Scalp tenderness (pain when combing hair or resting head on pillow)
- Jaw claudication — pain or fatigue in the jaw muscles while chewing
- Sudden painless vision loss in one eye
- Brief episodes of vision loss as a warning sign (amaurosis fugax)
- Fatigue, unexplained weight loss, and fever
- Pain or stiffness in the shoulders and hips (polymyalgia rheumatica)
- Double vision
Common Causes of Giant Cell Arteritis (GCA)
- Autoimmune inflammation of medium and large blood vessels
- Age — almost exclusively affects people over 50, peak incidence in the 70s
- Genetic predisposition — more common in people of Northern European descent
- Association with polymyalgia rheumatica (PMR)
- Female sex — women are affected 2-3 times more often than men
How We Evaluate Giant Cell Arteritis (GCA)
Urgent blood work is the first step — ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) are typically markedly elevated. A CBC may show anemia and elevated platelets. The definitive diagnostic test is a temporal artery biopsy, which shows characteristic inflammation in the vessel wall. However, treatment must NOT wait for biopsy results. Biopsy remains positive for up to two weeks after starting steroids. Ultrasound of the temporal arteries is an emerging diagnostic tool.
Treatment Options
Immediate high-dose corticosteroids are the treatment of choice. If vision loss has already occurred or is threatened, intravenous methylprednisolone (1 gram daily for 3 days) is given, followed by high-dose oral prednisone. The goal is to prevent vision loss in the second eye — once vision is lost from GCA, it rarely recovers. Tocilizumab (Actemra) is an FDA-approved steroid-sparing agent that helps reduce cumulative steroid exposure.
- Immediate high-dose intravenous methylprednisolone (if vision loss has occurred)
- High-dose oral prednisone with gradual taper over months to years
- Tocilizumab (Actemra) — FDA-approved steroid-sparing agent
- Temporal artery biopsy (does not delay treatment)
- Monitoring of inflammatory markers (ESR, CRP) to guide taper
- Bone density protection and other steroid side-effect management
Why Choose Dr. Ghiam for Giant Cell Arteritis (GCA)
- Rapid recognition of GCA — time is vision
- Emergency evaluation and same-day treatment initiation
- Expert coordination of temporal artery biopsy
- Long-term steroid taper management with steroid-sparing strategies
- Monitoring for visual and systemic complications
GCA-related vision loss is one of the few true ophthalmic emergencies. A neuro-ophthalmologist can rapidly recognize the clinical signs, distinguish GCA from other causes of sudden vision loss like NAION, initiate immediate treatment, coordinate the temporal artery biopsy, and manage the long-term steroid taper. Time is vision — and expertise matters.
Get Expert Help for Giant Cell Arteritis (GCA)
If you are over 50 and experiencing a new severe headache, jaw pain, scalp tenderness, or sudden vision loss, this may be a medical emergency. Call us immediately or go to the nearest emergency room.