What are the characteristics of patients reporting diplopia in giant cell arteritis?
Reviewed by Lauren Hepworth

The authors present a retrospective study of individuals diagnosed with giant cell arteritis (GCA) consecutively over a six-year period at a single tertiary ophthalmic centre. The characteristics of binocular diplopia prior to GCA diagnosis was collected from medical records and comparisons made with individuals diagnosed with GCA without diplopia. Other data including demographics, clinical, laboratory and radiological examinations were extracted from the records. All individuals with persistent (>24 hours) ophthalmic symptoms were referred for a full ophthalmic assessment. A total of 111 individuals were diagnosed with GCA over the study period of which 30 reported diplopia. Ninety percent of cases reported diplopia was persistent. Of those reporting diplopia the mean age was 74 years and the majority were female (70%). No differences in clinical presentation were found between those reporting and not reporting diplopia. The median time between diplopia onset and GCA diagnosis was 10 days. The findings on detailed ocular mobility examination were third cranial nerve palsy (n=11), sixth cranial nerve palsy (n=10), in two cases both were co-existent, and fourth cranial nerve palsy (n=2). Forty percent of cases with diplopia resolved in less than one week. Visual impairment was not experienced by 43% of those with persistent diplopia. Cases without diplopia were more likely to experience ocular complications. Of those with persistent diplopia (n=13), 92% resolved. Only one case continued to report diplopia beyond six months after therapy commencement. Patients either received intravenous methylprednisolone or oral corticosteroids. Duration of diplopia was shorter with intravenous therapy versus oral by a median of five days. No differences were found between individuals with and without diplopia in terms of clinical, biological or morphological findings. The authors acknowledged the retrospective and single centre design as limitations. Further research is required to establish if GCA patients with diplopia are at risk of visual complications and treatment options to prevent these.

Characteristics and prognosis of binocular diplopia in patients with giant cell arteritis.
Chazel T, Clavel G, Leturcq T, et al.
JOURNAL OF NEURO-OPHTHALMOLOGY
2024;44:87–91.