A 62-year-old woman presents with sudden painless inferior altitudinal visual field loss in the right eye. Fundoscopy shows a swollen, hyperemic optic disc with peripapillary flame haemorrhages. ESR is 15 mm/hr. Which is the most important next step?
- A Start high-dose oral prednisolone immediately ✓
- B Observe and follow up in 6 weeks
- C Order temporal artery biopsy
- D Check HbA1c and lipid profile
Correct answer: A. Start high-dose oral prednisolone immediately
Explanation
This presentation is classic for arteritic anterior ischaemic optic neuropathy (B-AION) due to giant cell arteritis until proven otherwise. Normal ESR does not exclude GCA. High-dose corticosteroids must be started immediately to protect the fellow eye, as bilateral involvement occurs in up to 95% if untreated. Temporal artery biopsy can be done within 1-2 weeks of starting steroids. Observation risks catastrophic bilateral blindness.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.