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GCA Visual Loss Prognosis — SCE Rheumatology MCQ

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ModerateVasculitisGCA Visual Loss PrognosisSCE Rheumatology

A 72-year-old woman with biopsy-confirmed giant cell arteritis develops sudden, painless loss of all vision in her left eye. Fundoscopy shows pallid optic-disc swelling consistent with arteritic anterior ischaemic optic neuropathy. Intravenous methylprednisolone is started within hours, but there is no visual improvement after 3 days. Which statement most accurately describes the prognosis for the affected eye?

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Correct answer: B — Meaningful recovery is uncommon; severe established visual loss is usually permanent

Arteritic anterior ischaemic optic neuropathy causes infarction of the optic nerve head. Once profound visual loss is established, particularly with no perception of light and no early response to treatment, meaningful recovery is uncommon and the deficit is usually permanent. Small improvements can occur, so describing recovery as absolutely impossible would be too categorical; even when acuity improves, major visual-field loss may persist. Urgent high-dose glucocorticoids remain essential to suppress active GCA and reduce further ischaemic injury, especially to the fellow eye, rather than reliably restoring the affected eye. Tocilizumab can support disease control in selected relapsing or refractory GCA but does not reverse optic nerve infarction. Optic nerve sheath decompression has no established role, and substantial delayed recovery over 6–12 months is not the usual course.

Reference: Tucker SM, Haas SJ, Rizvi TZ. Predictors of Permanent Vision Loss in Giant Cell Arteritis. Neuroophthalmology. 2024;49(1):60–68. https://pubmed.ncbi.nlm.nih.gov/40919082/