Neuro-Ophthalmic
Arteritic Anterior Ischaemic Optic Neuropathy (Giant Cell Arteritis)
Also known as: AAION, arteritic AION, arteritic anterior ischaemic optic neuropathy, arteritic ischaemic optic neuropathy, GCA, giant cell arteritis, temporal arteritis, jaw claudication
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Systemic large-vessel vasculitis that threatens sight by infarcting the optic nerve head or occluding a retinal artery. Raises concern in a patient over 50 with new headache, scalp tenderness, jaw claudication, or transient or sudden monocular visual loss. Fellow-eye involvement can follow within days without treatment, so same-day emergency referral with urgent ESR and CRP is required rather than routine outpatient review.
Recognition
Symptoms: what patients report
- New headache in a patient over 50.
- Scalp tenderness or temporal pain.
- Jaw claudication, transient vision loss, or sudden monocular visual loss.
- Diplopia can occur and is an emergency association when paired with GCA symptoms or visual symptoms.
- A tonic pupil or anisocoria is not typical by itself, but should not reassure when paired with age-risk and GCA symptoms.
- Constitutional symptoms such as fatigue, weight loss, or fever.
- Pain and stiffness of the shoulder and hip girdles, often worse in the morning (polymyalgia rheumatica).
Signs: what the examination shows
- Visual loss may be transient or persistent.
- Temporal artery tenderness or reduced pulsation may be present.
- Optic neuropathy or retinal ischaemia may coexist.
- Pale, chalky-white swollen optic disc (arteritic anterior ischaemic optic neuropathy) — the characteristic finding.
What OptoGuide™ covers for arteritic anterior ischaemic optic neuropathy (giant cell arteritis)
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Arteritic Anterior Ischemic Optic Neuropathy (AAION) — EyeWiki
- Giant Cell Arteritis — EyeWiki
- The Neuro-Ophthalmology Survival Guide (Pane, Miller & Burdon) — standard reference text
- Ischemic Optic Neuropathies. Biousse V, Newman NJ. The New England Journal of Medicine. 2015;372(25):2428-36.
- Vision loss in giant cell arteritis: case-based review. Kokloni IN, Aligianni SI, Makri O, Daoussis D. Rheumatology International. 2022;42(10):1855-1862.
- Clinical Reasoning: A 62-Year-Old Woman With Transient Vision Loss. Tedesco Silva LM, Reategui JC, Tornes L, et al. Neurology. 2023;101(10):e1097-e1103.
- Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis. Kermani TA, Schmidt J, Crowson CS, et al. Seminars in Arthritis and Rheumatism. 2012;41(6):866-71.
- Occult giant cell arteritis: ocular manifestations. Hayreh SS, Podhajsky PA, Zimmerman B. American Journal of Ophthalmology. 1998;125(4):521-6.
- British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis: executive summary. Mackie SL, Dejaco C, Appenzeller S, et al. Rheumatology (Oxford). 2020;59(3):487-494.
- Ocular manifestations of giant cell arteritis. Hayreh SS, Podhajsky PA, Zimmerman B. American Journal of Ophthalmology. 1998;125(4):509-20.
- Giant cell arteritis: Its ophthalmic manifestations. Hayreh SS. Indian Journal of Ophthalmology. 2021;69(2):227-235.
- 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis. Ponte C, Grayson PC, Robson JC, et al. Annals of the Rheumatic Diseases. 2022;81(12):1647-1653.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.