2. Mrs JC
76 years old
LTG diagnosed 2010 IOP R15 L17
Treated with Xalatan
Nov 19 2013 RVA 6/9 LVA 6/9
IOP R13 L17
3.
4.
5. PHx PMR
Mentioned in passing “ eyes were
playing up” with visual disturbance on
Left side 2 days previously and a “heavy”
head
Complained to the Field Tester that she
was having trouble with LE and felt Left
field was worse.
Didn’t mention any other symptoms
6.
7. Represented via GP 6 days later
(25/11/13)
RVA NLP LVA vague HM
R RAPD
13. Beware to Stoic Little Old Lady with any of
these 4
› Amaurosis Fugax
› New Headache
› New Diplopia
› Facial/Neck/ Mouth/Jaw Pain
14. Amaurosis Fugax
Fleeting (seconds to mins)painless
significant loss of vision in one eye
Severe dimming/Blackout/curtain(partial
field loss)
No aura and no neuro symptoms
No persistence
Exact nature of the symptoms and
associated symptoms
Normal examination with no emboli
15. Monocular vision loss
Recent onset of Diplopia
New Headache
Unwell, loss of appetite or weight or night
sweats or fever, muscle aches and pains
Face/mouth/tongue/jaw/ throat/ear
eye/scalp ache
Scalp tenderness
Other recent illness
16. Temporal
Scalp and Temporal artery tenderness
Can be diffuse and bifrontal
New in character
17. Monocular vision loss
Recent onset of Diplopia
New Headache
Unwell, loss of appetite or weight or night
sweats or fever, muscle aches and pains
Face/mouth/tongue/jaw/ throat/ear
eye/scalp ache
Scalp tenderness
Other recent illness
18. Jaw claudication is only the classic
symptom
Any ache from scalp to ear to neck
Tongue pain with talking
Throat with swallowing
Ocular ischaemic pain with orbit or eye
pain on standing
19. Monocular vision loss
Recent onset of Diplopia
New Headache
Unwell, loss of appetite or weight or night
sweats or fever, muscle aches and pains
Face/mouth/tongue/jaw/ throat/ear
eye/scalp ache
Scalp tenderness
Other recent illness
20. A new symptom
Can be fleeting or persistent
Vertical or Horizontal
21. Monocular vision loss
Recent onset of Diplopia
New Headache
Unwell, loss of appetite or weight or night
sweats or fever, muscle aches and pains
Face/mouth/tongue/jaw/ throat/ear
eye/scalp ache
Scalp tenderness
Other recent illness
22. Ocular exam usually normal
Tender swollen Temporal artery
Carotid auscultation
Rarely signs of ocular ischaemia
› Dilated veins, retinal haemorrhages,uveitis
› Corneal oedema
23.
24. What do you do if someone over 6o says in
passing
› Lost vision in one eye
› New Headache
› New Diplopia
› Facial/Neck/ Mouth/Jaw Pain/orbital
pain
25. Ask your questions
One confirming symptom
Normal or suggestive ocular examination
› GP or Ophthalmologist urgently
Request exclusion of GCA
› Yes you will be wrong more often than
not. The price of vision is eternal vigilance
26. In AION caused by GCA the time course to
2nd eye blindness is usually
a. Hours
b. Days
c. Weeks
d. can be any of above
27. A new diffuse headache in the elderly is
a. unlikely to be GCA due to poor
localization
b. Requires urgent clinical assessment
c. Can be referred for GP assessment in a
few days.
d. probably migraine
28. Why is aggressive investigation and
treatment required in possible GCA
a. to prevent haemorrhagic stroke
b. to prevent permanent bilateral
blindness
c. to avoid steroid complications
d. to reduce unnecessary osteoporosis