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To the Editor.
—Bilateral loss of vision from anterior ischemic optic neuropathy due to untreated giant cell arteritis may occur simultaneously or the second eye may become involved as early as several days later. Indeed, Egge et al1 reported involvement of the fellow eye at one to five days in seven of 14 patients. Although oral corticosteroid therapy (for example, prednisone, 80 to 100 mg/d) is commonly used after anterior ischemic optic neuropathy in one eye in this setting, occasional cases have been reported in which severe visual loss occurs in the fellow eye despite this mode of therapy.2 Several investigators,3 therefore, have promoted the use of high-dose intravenous corticosteroids at the onset of unilateral involvement. The rationale for this is twofold: to best achieve a protective effect on the fellow eye in the early vulnerable period and to recover vision in the initially involved eye.4
Slavin ML, Margolis AJ. Progressive Anterior Ischemic Optic Neuropathy due to Giant Cell Arteritis Despite High-Dose Intravenous Corticosteroids. Arch Ophthalmol. 1988;106(9):1167. doi:10.1001/archopht.1988.01060140327015