On rare occassions, associated myocardial infarctions have been noted. The ESR is often markedly elevated, but a normal ESR may be seen. A positive temporal artery biopsy typically demonstrates granulomatous inflammation with lymphocytes, plasma cells, polymorphonuclear leukocytes, and giant cells. The most common ocular complication is anterior ischemic optic neuropathy secondary to ischemia of the cilliary artery and its branches. This produces loss of vision to the point of hand motion, light perception or no light perception.
Patients can present with afferent pupillary defect and painless decreased vision.
Ischemic optic neuropathy associated with giant cell arteritis. The optic disc appears pale and swollen, and peripappilarry hemorrhages are seen. Rarer causes of blindness associated with GCA include central retinal artery occlusion or branch retinal artery occlusion. Flame shaped hemorrhages, at or near the disc margin, and cotton-wool spots may be seen. Oculomotor and abducen nerve palsies are relatively common.