Eye Symptoms After 50 - Giant Cell Arteritis Awareness Guide

If you're over 50 and experiencing new eye symptoms along with headaches or other concerning signs, you need to know about giant cell arteritis (GCA)—a condition that can cause permanent blindness if not treated immediately. This guide will help you recognize the warning signs and understand why urgent action is essential.

What Is Giant Cell Arteritis?

Giant cell arteritis (GCA), also called temporal arteritis, is an inflammatory condition affecting the walls of arteries, particularly in the head and neck. When inflammation blocks blood flow to the eyes or optic nerves, sudden, permanent vision loss can occur.

GCA is a medical emergency because:

• Vision loss happens suddenly and is usually irreversible
• The second eye can be affected within days
• Treatment prevents blindness in the unaffected eye

Who Is at Risk?

GCA almost exclusively affects people over 50. Risk increases with:

• Age: Rare under 50, peak incidence in 70s and 80s
• Sex: Women are 2-3 times more likely than men
• Ethnicity: More common in people of Northern European descent
• History of polymyalgia rheumatica: Muscle pain and stiffness condition

Warning Signs of GCA

The Classic Symptoms

New Headache

• Often in the temples (one or both sides)
• Different from any headache you've had before
• May be severe or just persistent and unusual
• Tender to touch over the temple arteries

Scalp Tenderness

• Pain when brushing or combing hair
• Tender when lying on a pillow
• Sensitivity over the temples

Jaw Claudication

• Jaw pain or fatigue when chewing
• Pain increases with prolonged chewing
• One of the most specific symptoms for GCA
• Different from TMJ (jaw joint) problems

Visual Symptoms

• Transient vision loss—episodes of vision going gray or black
• Sudden vision loss in one eye
• Double vision
• Dimming or blurring

Other Symptoms

• Fatigue and feeling unwell (malaise)
• Weight loss without trying
• Fever or night sweats
• Muscle aches, especially shoulders and hips (polymyalgia rheumatica)
• Tongue pain

How GCA Causes Vision Loss

Ischemic optic neuropathy is the most common cause of vision loss in GCA. Inflammation blocks the arteries supplying the optic nerve, cutting off blood flow. Without blood, nerve tissue dies rapidly.

Why timing matters:

• Once vision is lost, it rarely recovers significantly
• The other eye can be affected within days to 2 weeks
• Starting treatment immediately protects the remaining eye

What to Do If You Have Warning Signs

Where to Go

• Emergency room: If you have vision loss
• Urgent care or same-day doctor: For warning symptoms without vision loss
• Call your eye doctor urgently: They may expedite evaluation

What to Tell the Doctor

• Your exact age
• When symptoms started
• All symptoms, even if they seem unrelated
• Any recent vision changes, even if temporary
• Family history of GCA or polymyalgia rheumatica

Diagnosis of GCA

Blood Tests

Blood tests are an essential first step:

ESR (Erythrocyte Sedimentation Rate)

• Measures inflammation
• Usually very elevated in GCA (often >50-100)
• Not specific to GCA—can be elevated for other reasons

CRP (C-Reactive Protein)

• Another inflammation marker
• Often elevated along with ESR
• Together, ESR and CRP are very sensitive for GCA

Complete Blood Count

• May show anemia
• May show elevated platelets

Temporal Artery Biopsy

Temporal artery biopsy is the gold standard test:

• A small piece of the temporal artery is removed
• Examined under microscope for inflammation
• Usually performed within days of starting treatment
• Treatment should NOT be delayed for biopsy
• Biopsy can remain positive for 2-6 weeks after starting steroids

Imaging

• Ultrasound of temporal arteries may show a "halo sign"
• CT or MRI may be used in some cases
• Imaging can support diagnosis but doesn't replace biopsy

Treatment: Why Steroids Are Essential

IV Steroids

For patients with vision loss or high-risk features:

• Methylprednisolone 1 gram IV daily for 3-5 days
• Urgently reduces inflammation
• May help salvage some vision if given very early

Oral Steroids

Prednisone is the cornerstone of treatment:

• High doses (40-60 mg or more) initially
• Symptoms often improve within days
• Very slow taper over 1-2 years
• Stopping too quickly risks relapse

Tocilizumab (Actemra)

A newer medication that can be added:

• Allows lower steroid doses
• Reduces relapse risk
• Given as injection or IV infusion
• FDA-approved for GCA

Why Treatment Is Long

• GCA requires months to years of treatment
• Tapering too fast causes relapse
• Relapses risk vision in the other eye
• Regular monitoring with blood tests (ESR, CRP) guides tapering

Protecting Your Vision

If You Haven't Lost Vision Yet

• Treatment prevents vision loss in most cases
• Take steroids exactly as prescribed
• Report any visual symptoms immediately
• Don't miss follow-up appointments

If You've Lost Vision in One Eye

• The priority is protecting the other eye
• High-dose steroids reduce risk to the fellow eye
• Vision loss in the affected eye is usually permanent
• Low vision resources can help with adaptation

Living with GCA Treatment

Long-term steroid treatment comes with challenges. See our Living with Steroid Treatment guide for detailed information on managing side effects.

Key Points

• Bone protection (calcium, vitamin D, sometimes bisphosphonates)
• Blood sugar monitoring
• Blood pressure monitoring
• Watch for infections
• Never stop steroids suddenly

Monitoring

During treatment, expect regular:

• Blood tests (ESR, CRP) to track inflammation
• Symptom assessment
• Watch for steroid side effects
• Adjustment of medication doses

Frequently Asked Questions

Can vision loss from GCA be reversed?

Unfortunately, vision loss from GCA is usually permanent. This is why prevention through early recognition and treatment is so critical. Rarely, patients treated extremely early may see some improvement.

Will I definitely lose vision if I have GCA?

No. Many patients diagnosed with GCA warning symptoms never lose vision because treatment was started in time. Vision loss occurs when diagnosis is delayed.

How long will I need to take steroids?

Treatment typically lasts 1-2 years, sometimes longer. The duration depends on how your body responds. Tocilizumab can help reduce steroid exposure.

What if my biopsy is negative?

A negative biopsy doesn't completely rule out GCA because inflammation can be patchy in the artery. If clinical suspicion remains high, treatment may continue. Your doctor will make this judgment based on your full clinical picture.

Can GCA come back after treatment stops?

Yes, relapse is possible, usually within the first 2 years. This is why tapering is slow and monitoring continues. Symptoms like headache or elevated inflammatory markers may signal relapse.

Is GCA hereditary?

There's some familial tendency, but GCA isn't directly inherited. Having a family member with GCA or polymyalgia rheumatica may slightly increase your risk.

Can I take aspirin for GCA?

Low-dose aspirin is often added to steroid therapy because GCA increases the risk of stroke and heart attack. However, aspirin alone does not treat GCA—steroids are essential.

What happens if I miss my steroid dose?

Take it as soon as you remember. Missing occasional doses is unlikely to cause immediate problems, but consistently missing doses risks relapse. Never stop steroids abruptly—this can be dangerous.

When to Seek Emergency Care

Summary: The Key Message

If you're over 50 and experience:

1. New headache (especially at temples)
2. Scalp tenderness
3. Jaw pain when chewing
4. Visual disturbances

Seek medical attention TODAY. These symptoms may indicate GCA, and immediate treatment can prevent permanent blindness. Don't wait to see if symptoms improve—in GCA, delays cost vision.

References