Dear Dr. Roach: My wife went blind in her left eye suddenly last October, and a biopsy showed temporal arteritis. She was started on high-dose prednisone, and after four weeks they lowered the dosage. Her right eye is blurry, and doctors recommended removing the cataract in hopes of helping her see better. What is her prognosis? Will she always have this? — J.B.
Answer: I am sorry to hear about your wife.
Temporal arteritis, also called giant cell arteritis, is the inflammation of large- and medium-sized blood vessels. The exact cause is not understood, but it does seem to have elements of an autoimmune disease; the body attacks its own blood vessels. This can lead to injury of the blood vessel, but in the case of the temporal artery in the forehead, it can lead to the dreaded complication your wife suffered: blindness due to poor blood flow to the optic nerve and retina. The vision loss is permanent. The other eye will be affected 25-50% of the time in untreated patients, which is why she was started on high-dose prednisone. It dramatically reduces the risk of further loss in the opposite eye.
I’m not sure whether her blurry right eye is due to the temporal arteritis or to the cataract. Even if the vision in her right eye was affected by the arteritis, removal of a symptomatic cataract may help her vision. How effective the surgery will be depends entirely on how large and dense the cataract is. With continued prednisone treatment, the cataract may worsen more quickly than it would without steroids.
Many people have specific warning symptoms prior to vision loss, such as headache or pain in the jaw with chewing, but others have only vague symptoms such as fever, weight loss and fatigue. These specific findings should be brought to medical attention urgently. Unexplained vague symptoms should also be considered as possibly due to giant cell arteritis. A blood test, the ESR, is usually very elevated in giant cell arteritis.
Since disease can flare when the prednisone dose is decreased, her doctor should be monitoring symptoms closely. Most people are eventually able to get off of prednisone treatment after a year or two, but in others it may take longer.
