Researchers recently discovered patients with giant cell arteritis (GCA) who present with diplopia, whether transient or constant, often also have other serious systemic symptoms that warrant further work-up.

In studying 27 patients with diplopia from GCA and 67 control subjects who had diplopia from other etiologies, investigators noted those with GCA were more likely to also complain of other accompanying visual symptoms and systemic GCA symptoms such as headache, jaw claudication and scalp tenderness. They also found GCA patients were more likely to have ocular ischemic lesions, and their inflammatory markers were elevated significantly compared with controls.

“GCA is a rare but serious cause of diplopia among older adults and must be differentiated from other more common benign etiologies,” the researchers wrote. “Our study suggests that most patients with diplopia from GCA have concerning systemic symptoms and/or elevated inflammatory markers that should trigger further work-up. Moreover, careful ophthalmoscopic examination should be performed to look for presence of ocular ischemic lesions in older patients presenting with acute diplopia.”

Ross AG, Jivraj I, Rodriguez G, et al. Retrospective, multicenter comparison of the clinical presentation of patients presenting with diplopia from giant cell arteritis vs other causes. J Neuroophthalmol. April 24, 2018. [Epub ahead of print].