What Is Temporal Arteritis?
Temporal arteritis is an inflammation of and damage to blood vessels that supply the head and eyes. While the disease, which is also called giant cell arteritis, can occur in any medium or large artery, it occurs most commonly in the temporal arteries leading from the carotid artery. The name giant cell arteritis refers to the type of inflammatory cells seen on the microscope from a temporal artery biopsy.
Temporal arteritis involves a variety of symptoms including tenderness in the scalp, headaches, pain in one or both temples, fatigue, double vision, neck pain, weight loss and pain in the jaw, especially while chewing. Temporal arteritis can lead to a secondary disorder called arteritic ischemic optic neuropathy (AION). The inflammation in the temporal artery causes the artery to swell, preventing nutrients from reaching the optic nerve. AION presents as a sudden loss of vision in one eye, caused by a decrease in blood flow to the optic nerve.
The sudden loss of vision with AION is often preceded by the other symptoms described above, and patients often describe flu-like symptoms including fever, body aches, stiffness and headache. There is a general sense of feeling unwell that may also result in an unexplained loss of weight.
Some of the risk factors for temporal arteritis and AION are:
- Your age: Usually occurs in people over age 60
- Your race: Caucasians and, in particular, people of Scandinavian decent are at greater risk
- Your gender: Women are at least twice as likely as men to have temporal arteritis
An additional risk factor is an arthritic disease called polymyalgia rheumatica (PMR) whose symptoms include stiffness and pain in the neck, shoulders and hips.
Because permanent vision loss including blindness can result if left untreated, the symptoms of temporal arteritis should not be ignored. Therefore, you should see your physician if you are experiencing any of the symptoms noted above. Prompt diagnosis and treatment may prevent vision loss.
If you experience a sudden loss of vision, you should contact your eye doctor immediately.
How Is Temporal Arteritis Detected?
For any sudden vision loss, your eye doctor will normally conduct the following tests:
- Dilated eye exam / slit lamp examination: A comprehensive examination of your eye and retina
- Tonometry: Measuring your intraocular pressure
- Ophthalmoscopy: Evaluating any optic nerve damage
- Visual field testing: Measuring the sensitivity of central and peripheral (sideways) vision
Additionally, if your doctor suspects temporal arteritis, he may order blood tests that measure your erythrocyte sedimentation rate (ESR), how quickly your red blood cells fall to the bottom of a test tube, and your C-reactive protein (CRP) level, how much CRP your liver is producing. These tests are sometime helpful in assessing the level of overall inflammation in your body, but not very specific for this condition.
To definitively diagnosis temporal arteritis, biopsy of the temporal artery is often necessary. Your eye care specialist may refer you to a neuro-ophthalmologist or vascular surgeon to conduct a biopsy of your temporal artery. This biopsy, which is done under local anesthesia, would determine if giant cell inflammation is present. However, because the biopsy takes only a small tissue sample, it is possible to have a false negative result.
How Is Temporal Arteritis Treated?
If your doctor suspects that you have temporal arteritis, he will normally begin treatment with oral corticosteroid medication, even before a temporal biopsy confirms the diagnosis. This is to prevent further vision loss. In addition, immuno-suppressing medications, such as methotrexate, may also be prescribed to minimize the amount of steroids prescribed.
Corticosteroids are very effective at reducing inflammation. However, long term use can lead to complications including high blood pressure, cataracts and glaucoma. In this case, the benefits far out-weigh the risks.
Most patients notice an improvement in how they feel within a few days. In some people, the long-term use of medication may be necessary. If so, regular blood testing, including the sediment rate and CRP, will be necessary to monitor your progress. Your eye doctor will work closely with your internist or rheumatologist in monitor your overall health and vision.
It should be noted that the use of corticosteroids and other medications is unlikely to restore vision that has been lost, but is crucial in preventing loss of vision in the unaffected eye. This is why it is important for you to see your doctor as soon as you experience symptoms of temporal arteritis. If the disease can be effectively treated before AION impacts your optic nerve, preventing vision loss and even blindness is possible.
Neuro-Ophthalmology Specialist at Kadrmas Eye Care New England
Meet our neuro-ophthalmologist who specializes in the treatment of neurological eye diseases and disorders: