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GCA Protect Contralateral Eye — SCE Rheumatology MCQ

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ModerateRheumatology EmergenciesGCA Protect Contralateral EyeSCE Rheumatology

A 55-year-old woman develops sudden painless visual loss in one eye. She has known GCA on Prednisolone 40 mg daily (started 3 days ago for new GCA diagnosis). Despite treatment her vision does not recover. What is the most urgent priority?

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Correct answer: C — The most urgent priority is protecting the contralateral eye which is at imminent risk (up to 50% develop bilateral involvement within days to weeks without adequate treatment); ensure glucocorticoid dose is adequate and consider IV Methylprednisolone

In GCA-related visual loss the affected eye's vision rarely recovers once established (AION causes permanent infarction). The most critical clinical priority is protecting the contralateral eye. Without adequate treatment up to 50% of patients develop bilateral visual loss often within days to weeks. BSR 2020 GCA guidelines recommend: ensuring the current glucocorticoid dose is adequate (IV Methylprednisolone 500 mg-1 g daily for 3 days may be considered for acute visual loss) urgent ophthalmological assessment and close monitoring of the contralateral eye. Tocilizumab may be added for steroid-sparing but does not replace high-dose acute glucocorticoid therapy.

Reference: BSR 2020 GCA guidelines; Hayreh SS et al 1998