Temporal Arteritis Related Arteritic Anterior Ischemic Optic Neuropathy

Temporal arteritis (Giant cell arteritis) is an autoimmune systemic disease affecting the elderly population characterized by granulomatous vasculitis involving the mid-large size vessels. Classical systemic symptoms include headache, skin sensitivity in the temporal region and jaw fatigue. Inflammation involving the posterior ciliary arteries leads to arteritic anterior ischemic optic neuropathy (AAION) which causes sudden vision loss. Temporal artery biopsy is the gold standard for diagnosis and should be applied to all patients suspected of the disease. As early diagnosis and treatment is of vital importance in terms of improvement of visual loss and prevention of other ocular involvement, AAION is considered to be a neuroophthalmologic emergency. The gold standard in treatment is steroids. There is no consensus in the literature regarding the optimal therapeutic approach in cases with steroid resistance. Biological agents, especially tocilizumab, are promising in refractory cases. Up-to-date steroids are the first step in the treatment algorithm, tocilizumab is recommended in the second line; however, in cases with progression, abatacept, ustekinumab and anakinra are recommended as last-line treatments.