Sudden vision loss in one eye needs same-day care. Call an eye doctor or go to the emergency department.

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Home For Eye Doctors GCA checklist for eye doctors

GCA checklist for eye doctors

Suspected giant cell arteritis: a same-day work-up

Reviewed by Dr. James Deom, OD, MPH, FAAO, FSLS, Chief of Eye Care Services, Hazleton Eye Specialists Last reviewed: November 12, 2026 Audience: Optometrists and ophthalmologists

Same-day care

Sudden vision loss in one eye needs same-day care.

Call an eye doctor or go to the emergency department.

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Use this checklist for any patient over 50 with acute vision loss, transient monocular vision loss, diplopia, or optic disc edema, including patients on GLP-1 RAs in whom NAION is suspected. It summarizes published guidance and is not a substitute for it.¹ ² Background is on Giant cell arteritis and arteritic AION.

1. History

  • [ ] New headache, temporal or occipital
  • [ ] Scalp tenderness
  • [ ] Jaw claudication (ask specifically; often the most specific symptom)
  • [ ] Fever, fatigue, night sweats, anorexia, weight loss
  • [ ] Proximal girdle pain and stiffness (PMR)
  • [ ] Transient monocular vision loss or transient diplopia before this event
  • [ ] Prior steroid use (may mask markers and lower biopsy yield)
  • [ ] GLP-1 RA agent, dose, and start date, if applicable

2. Examination

  • [ ] Visual acuity and color vision each eye
  • [ ] Pupils: RAPD
  • [ ] Confrontation or automated visual fields
  • [ ] Dilated exam of both discs: pallid (“chalky-white”) edema suggests AAION; note cup size in the fellow eye (a normal-sized cup in the fellow eye argues against NAION)³
  • [ ] Look for cilioretinal artery occlusion, CRAO, cotton-wool spots
  • [ ] Ocular motility (diplopia)
  • [ ] Palpate temporal arteries (tenderness, nodularity, reduced pulse)
  • [ ] Document with OCT RNFL/GCL, OCTA, and fundus photos as feasible without delaying care
  • [ ] If the disc is normal with acute loss, consider PION (see PION)

3. Same-day labs

  • [ ] ESR
  • [ ] CRP
  • [ ] CBC with platelets (thrombocytosis supports GCA)
  • [ ] Remember: normal markers lower but do not exclude the probability

4. Treatment: do not wait

  • [ ] If GCA is suspected, start high-dose glucocorticoids the same day, or send the patient to the emergency department for initiation. Do not delay for biopsy or imaging.¹
  • [ ] With vision loss or threatened vision, coordinate oral versus IV pulse dosing with the treating team, as addressed in the ACR guideline.¹
  • [ ] Screen for contraindications and arrange glucose and blood pressure monitoring with the primary care team

5. Confirm the diagnosis

  • [ ] Temporal artery biopsy (ACR favors a long segment) arranged promptly, since yield falls with time on steroids,¹ ⁴ or
  • [ ] Vascular ultrasound of temporal and axillary arteries where local expertise exists (EULAR 2023)²

6. Communicate and document

  • [ ] Call the primary care clinician the same day; refer to rheumatology
  • [ ] If the patient is on a GLP-1 RA, notify the prescriber and document that GCA was evaluated before attributing the event to NAION
  • [ ] Record symptoms, exam, labs, steroid start time and dose, and plan
  • [ ] Counsel the patient and family on fellow-eye risk and when to return immediately
  • [ ] Arrange follow-up within days

Dr. Deom’s recommendation (clinical opinion / practice recommendation)

Dr. James Deom recommends that everyone starting or taking a GLP-1 medication have a comprehensive dilated eye exam with OCT, OCT angiography (OCTA), and retinal photography (fundus photos with autofluorescence) as a baseline and for follow-up, and seek same-day care for sudden vision loss.

This is his clinical opinion and practice recommendation, not a society mandate. AAO and NANOS do not recommend routine examination solely to predict NAION, and no exam or imaging test reliably predicts or prevents an acute event. The baseline is intended to document disc anatomy and retinal status for later comparison and to detect other eye disease. See the study comparison for where professional positions agree and differ.

Dr. James Deom’s personal clinical thought

This is his opinion, not established evidence. It is not a finding from the studies or a position of the FDA, EMA, AAO, NANOS, or AOA.

As patients lose weight and their overall health improves on GLP-1 medicines, blood pressure and cholesterol medicines are often not re-addressed. Over-treatment of blood pressure may lead to hypotension, which can worsen at night and could cause nighttime hypoperfusion of the optic nerve. That sequence would fit the typical presentation of NAION (vision loss noticed on waking).

He recommends that people on GLP-1 medicines also improve exercise and diet, and keep regular visits with their usual doctors, even if that clinician did not prescribe the GLP-1, so the rest of their care, including blood pressure, is maintained.

For prescribers: consider reviewing antihypertensive dosing and timing (including bedtime dosing) as weight drops. Coordinate changes with the patient’s usual clinician when someone else wrote the GLP-1 prescription.

How to reach us

Same-day evaluation: providers can call the office at 570-453-2020 (fax 570-453-1020), or refer a patient or ask a question by email. Patients can schedule an exam online.

For privacy, please don’t include patient names or other identifying details in email. Our team will call to schedule and gather details securely.

General contact and referrals: Hazleton Eye Specialists, phone 570-453-2020, fax 570-453-1020. See Referral information for what to send.

References

  1. Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis. Arthritis Rheumatol. 2021;73(8):1349-1365. https://pubmed.ncbi.nlm.nih.gov/34235884/
  2. Dejaco C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update. Ann Rheum Dis. 2024;83(6):741-751. https://pubmed.ncbi.nlm.nih.gov/37550004/
  3. Hayreh SS, et al. Ocular manifestations of giant cell arteritis. Am J Ophthalmol. 1998;125(4):509-520. https://pubmed.ncbi.nlm.nih.gov/9559737/ · Biousse V, Newman NJ. Ischemic Optic Neuropathies. N Engl J Med. 2015;372(25):2428-2436.
  4. Papadakos SP, et al. The Effect of Corticosteroids on Temporal Artery Biopsy Positivity in Giant Cell Arteritis: Timing is Everything. J Clin Rheumatol. 2023;29(4):173-176. https://pubmed.ncbi.nlm.nih.gov/36728371/

Medical disclaimer. This checklist is educational and intended for licensed eye-care professionals. It is not a clinical practice guideline and does not replace clinical judgment, product labeling, or specialty consultation. Information is current as of the “last reviewed” date.