Giant cell (senile, temporal or cranial) arteritis occurs three times more frequently in women and the majority of patients are over 70 years of age. This series of forty-seven patients presented with visual symptoms and most also had a constitutional upset. The ocular signs were of ischaemic papillopathy (in 80%), which was unilateral in 61% and bilateral in 17%; or central retinal artery occlusion (13%). The ESR was always elevated above 40 mm, and in 28% it was above 100 mm. The main ophthalmic differential diagnosis was to determine whether it was arteritic or atherosclerotic ischaemic papillopathy in this age group, and principal differences are outlined (Table 6). Following corticosteroid therapy, vision improved in 23%, remained unchanged in 64% and deteriorated in 13% of patients. Visual deterioration predominated in elderly women who received steroids late in the course of the disorder. Early steroid therapy is recommended in elderly patients with visual symptoms and significantly raised ESRs.
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