Temporal arteritis. Occurrence of ocular complications 7 years after diagnosis.

One of the major problems in the management of patients with temporal arteritis, par- ticularly those in whom loss of vision in one eye has already occurred, is to decide for how long corticosteroid therapy should be continued.The following case report is presented because it suggests that the disease process may remain active for a very long time, in this instance 7 years, and even then, despite treatment, complete immunity from complications cannot be assured. Case reportApril, I964 A music teacher, aged 64 years, came to the Eye Department because of severe frontal headache of 3 weeks' duration.Because of tenderness in the temples a diagnosis of temporal arteritis was suspected and this was confirmed by temporal artery biopsy.The erythrocyte sedimentation rate was 83 mm. in the first hour.There were no ocular symptoms, visual acuity was 6/6 and Ns in each eye, and examination of the eyes revealed no abnormality.Treatment with prednisolone was instituted and brought about a complete remission of symptoms.I 964-I 965 In the course of the ensuing i8 months the dose of prednisolone was maintained between io and 20 mg.daily depending on the erythrocyte sedimentation rate which was taken at monthly intervals.In November, I964, this had risen to go mm.and in September, I965, a reading of IO5 mm. in the first hour was obtained.On these occasions the dosage was increased until the level fell again although readings under 40 mm.were never attained over this whole period.In October, I965, temporal artery biopsies were taken from each temple and showed no evidence of active disease.Full medical investigation was also carried out at this stage and no other disease process was identified.I966-I970 Prednisolone therapy was continued during this period but erythrocyte sedimentation rate readings of over 8o mm. were recorded on a number of occasions in I966 and I967.By 1968, readings around 40-50 mm. were usual, but eventually in I 969 a maintenance dose of 5 mg.daily was achieved, the erythrocyte sedimentation rate at this stage usually remaining under 40 mm. February, 1971The patient presented as an emergency because of visual loss in the right eye of 6 hours' duration.The visual acuity had dropped to 6/6o and Ni8; the pupil reaction was not impaired but the disc