Tag Archives: ischemic optic neuropathy

Giant Cell Arteritis and the Eyes

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is giant cell arteritis (GCA)?

Giant cell arteritis (also called cranial arteritis or temporal arteritis) is an inflammatory condition affecting medium to larger arteries in people over the age of 50 years.  GCA may cause headache, neck stiffness, tenderness of the temple, and/or cramping of the tongue or jaw while eating or talking.  It may also cause fever, fatigue, weight loss, depression, night sweats and general feeling of illness or feeling unwell.  

What causes giant cell arteritis (GCA)?

The cause of GCA is not very well understood.  The inflammation from GCA is not due to infection.  In GCA, it appears the body’s immune system attacks itself, in some ways similar to rheumatoid arthritis.    

How is giant cell arteritis (GCA) diagnosed?

The diagnosis is first suspected by typical symptoms in an older patient.  Blood tests may include complete blood count (CBC), sedimentation rate (ESR), and C-reactive protein (CRP).  Biopsy of the temporal artery is necessary in most cases to confirm to diagnosis.  Firmly establishing the diagnosis is critical, because treatment needs to be started quickly and continued for a long time in GCA. 

How does giant cell arteritis (GCA) affect the eyes?

Giant cell arteritis (GCA) causes loss of vision due to retinal artery occlusion or ischemic optic neuropathy.  Early diagnosis is critical to begin treatment and limit the damage from blood vessel inflammation, which includes complications of brain stroke. 

 How is giant cell arteritis (GCA) treated?

Prompt steroid treatment is important to stop inflammation from causing further damage with loss of vision and brain stroke.  Prednisone is continued at a low dose for a year or more to prevent the inflammation from returning.  In an effort to avoid or manage side-effects of steroids, methotrexate is sometimes used.  Tocilizumab was approved in 2017 for use in GCA.  It avoids the use of steroids, but is very expensive.

By Scott E Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2021-2022 Designs Unlimited of Florida.  All Rights Reserved.

Polymyalgia Rheumatica and your Eyes

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Anatomy of the eye

What is polymyalgia rheumatica (PMR)?

Polymyalgia rheumatica is an inflammatory condition affecting the hips and shoulders of people over the age of 50 years.  PMR may cause sudden shoulder and/or hip pain, especially after or during rest from activity.  It usually affects both sides of the body.  It may also cause fever, fatigue, weight loss, depression, and night sweats. 

What causes polymyalgia rheumatica (PMR)?

The cause of PMR is not very well understood.  The inflammation from PMR is not due to infection, though various infections may need to be excluded before a diagnosis of PMR is made.  In PMR, it appears the body’s immune system attacks itself, in some ways similar to rheumatoid arthritis.    

How is polymyalgia rheumatica (PMR) diagnosed?

The diagnosis is first suspected by typical symptoms in an older patient.  Blood tests may include complete blood count (CBC), sedimentation rate (ESR), and C-reactive protein.  If needed, ultrasound may detect bursitis in the shoulder.  PET/CT scan is also very sensitive and specific for PMR.    

How does polymyalgia rheumatica (PMR) affect the eyes?

When PMR is associated with inflammation of the blood vessels, the eye can become affected.  This closely-related blood vessel inflammation is called giant cell arteritis (also called cranial arteritis or temporal arteritis).  Giant cell arteritis (GCA) causes symptoms similar to PMR with the addition of headache, neck stiffness, tenderness of the scalp, and cramping of the tongue or jaw when speaking or chewing.  These symptoms indicate inflammation of the blood vessels of the head.  Loss of vision may occur due to retinal artery occlusion or ischemic optic neuropathy.  Early diagnosis is critical to begin treatment and limit the damage from blood vessel inflammation, which includes complications of brain stroke. 

By Scott E. Pautler, MD 

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2021-2022 Designs Unlimited of Florida.  All Rights Reserved.

ED Medication and Your Eyes: Viagra, Cialis, and Levitra

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globe anatomy
anatomy of the eye (click on image to enlarge)

What are ED medications?

Erectile dysfunction (ED) is a common problem among males involving an inability to achieve or maintain an erection. Medications have been developed to treat this condition. They work in part by promoting dilation of the blood vessels in the penis. This same dilation of the blood vessels also occurs in other parts of the body. Facial flushing, stuffy nose, and headache may result from vascular dilation in the head. A decrease in blood pressure may also occur due to pooling of blood in the larger dilated veins of the body. This drop in blood pressure may cause symptoms of insufficient blood flow, especially in patients with hardening of the arteries.

How can ED medications affect my eyes?

Medications prescribed for erectile dysfunction (ED) may cause temporary blurred vision, light sensitivity, or impaired color vision. If these symptoms occur, a decrease in dosage of medication may be in order. If these symptoms persist, contact your ophthalmologist.

Rarely, a severe permanent decrease in vision may occur after using ED medications…ischemic optic neuropathy. This condition occurs most often in patients with atherosclerosis (hardening of the arteries) and in eyes with crowded optic discs (often seen in far-sighted people). Any sudden decrease in blood pressure (including the use of ED medications) may precipitate ischemic optic neuropathy.

In some patients ED medications might aggravate central serous retinopathy (CSR). a condition more often seen in far-sighted eyes with a thick blood vessel layer in the choroid. This condition causes a round, blurred gray or brown spot in the center of the vision. If this symptom appears while taking ED medications, contact your ophthalmologist.

What other medicines or conditions might interact with ED Medications?

Certain foods and drugs may interact with ED medications. Eating grapefruit or drinking grapefruit juice may affect how your body eliminates ED medications from your body. The following medications should not be used with ED medications: nitrates (nitrogycerin, isosorbide), nitroprusside, certain recreational drugs called “poppers” (which contain amyl or butyl nitrite).

Other medications may also affect ED medications and should be reported to your doctor or pharmacist: prostate medications, blood pressure medications, HIV/AIDS medications, St. John’s wort, some seizure medications, and certain antibiotics.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2017-2022 Designs Unlimited of Florida. All Rights Reserved.