A 70-year-old female presents to her GP with a 6-day history of worsening left-sided headache and left eyelid swelling. Her symptoms started suddenly one morning and she has seen an emergency optician who diagnosed her with eye strain. She now has blurred vision in her left eye only and describes a worsening headache with pain radiating to her jaw associated with occasional loss of sensation across the left side of her face. She is not taking any regular medication, has no allergies and no significant past medical history. On examination, her scalp is very tender to touch, particularly in the left temporal region. Apart from the visual changes, the rest of the cranial nerve examination is normal. A diagnosis of giant cell arteritis (GCA) is made and her symptoms prompt urgent referral to the emergency eye clinic. The patient is started on 60 mg of oral prednisolone immediately. The patient is seen 4 hours later in the eye clinic and examination confirms left scalp tenderness with marked scleral injection and mild ptosis. Visual acuity is 6/7.5 in the right eye and 6/19 + 2 in the left. The cornea, anterior chambers and retina are normal bilaterally, with nuclear sclerosis in both lenses. The ophthalmologist arranges for bloods to be done (CRP = 12.5 and ESR = 8) and agrees to continue to treat the patient for GCA. She arranges for the patient to see a rheuma-tologist in their fast-track GCA clinic in 3 days.
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