Systemic Evaluation for Retinal Vasculitis

Immediate Priority: Rule Out Giant Cell Arteritis (GCA)

In patients over age 50, GCA must be excluded emergently as it represents a sight-threatening and life-threatening emergency, and the American Academy of Ophthalmology recommends obtaining immediately: Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count with platelets 1, 2
The American Academy of Ophthalmology suggests screening for GCA symptoms: Headaches, scalp tenderness, jaw claudication, temporal artery tenderness, malaise, fatigue, fever, diplopia, weight loss, polymyalgia rheumatica, or recent vision loss 1, 2
If GCA is suspected clinically, the American Academy of Ophthalmology recommends initiating systemic corticosteroids immediately before laboratory confirmation to prevent vision loss in the fellow eye 3

A comprehensive review of systems is critical to direct appropriate testing, and the American Academy of Ophthalmology suggests eliciting embolic disease symptoms: Transient ischemic attacks, lateralizing weakness, paresthesias, amaurosis fugax 1, 2
The American Academy of Ophthalmology recommends considering infectious exposures: Tuberculosis, syphilis, HIV, toxoplasmosis, histoplasmosis 4, 5, 6
The American Heart Association suggests assessing cardiovascular risk factors: Smoking, hypertension, diabetes, hyperlipidemia, atrial fibrillation 3, 7

In patients under 50 years old, the American Academy of Ophthalmology recommends focusing on vasculitis, hypercoagulability, and inflammatory conditions, and obtaining a hypercoagulability panel: Anticardiolipin antibodies, lupus anticoagulant, protein C/S, factor V Leiden if thrombotic features present 8
In patients over 50 years old, the American Academy of Ophthalmology suggests prioritizing embolic sources and cardiovascular disease, and performing urgent stroke evaluation: Refer to stroke center or emergency department within 24 hours for diffusion-weighted MRI 3, 9
The American College of Cardiology recommends embolic source investigation: Carotid duplex ultrasound, echocardiography (transthoracic or transesophageal), electrocardiogram 1, 2, 3

The American Academy of Ophthalmology notes that diabetic patients with suspected GCA require close glucose monitoring as systemic corticosteroid treatment will destabilize glycemic control 1, 2