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Granulomatous arterial inflammation in an older adult can cause irreversible ischaemic optic neuropathy and permanent blindness, sometimes without a marked headache.
Age over 50 with new temporal headache, scalp tenderness, jaw claudication, constitutional features, diplopia or transient visual loss is suspicious. Visual loss or diplopia is an immediate emergency.
Arrange same-day urgent ophthalmology and rheumatology/senior review; discuss immediate high-dose glucocorticoid treatment according to the established GCA visual-threat pathway. Record visual acuity in each eye.
Take inflammatory markers and platelets, and organise temporal artery ultrasound/biopsy through the fast-track service; blood investigations and imaging must not delay treatment when sight is threatened.
A normal or modestly elevated ESR alone does not safely exclude GCA. Ask specifically about amaurosis fugax, which can precede permanent loss of sight.
UK reference: NHS temporal arteritis. Focused editorial source check, 7 November 2026; this is not independent clinical or pharmacy sign-off. Verify current local policy, BNF/BNFC and specialist advice before treatment. Not a prescribing protocol.
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