When the Eyes Deceive: Uncommon Ophthalmic Presentation of Giant Cell Arteritis

Giant cell arteritis (GCA) is a systemic granulomatous large vessel vasculitis that predominantly affects older adults. We present a rare case of a patient in her 60s who presented with hypertension and isolated cranial nerve (CN) IV palsy. Initial imaging and temporal artery biopsy performed were negative. Her symptoms then resurfaced again after her prednisolone was stopped. Re-commencement of steroids led to a quick resolution of her visual symptoms and headaches within a matter of days. This case highlights the importance of clinical judgement and prompt initiation of steroids without delay. A gradual and prolonged steroid tapering regime is also essential to avoid visual loss, the most feared complication in GCA.