In AAION, what is the initial management step?

• A. Schedule outpatient oral steroids
• B. Refer to emergency department for blood work and IV methylprednisolone
• C. Initiate topical steroids
• D. Observe without treatment

Answer: (B)

AAION demands urgent, systemic anti-inflammatory treatment to prevent further vision loss and systemic vascular complications. When giant cell arteritis is suspected, high-dose systemic steroids should be started promptly, ideally in the ED or hospital, even before biopsy results. IV methylprednisolone provides rapid control of the inflammatory process and protects the fellow eye, with plans to transition to oral prednisone afterward and to obtain confirmatory testing (CRP/ESR, temporal artery biopsy). Topical steroids don’t affect the systemic vasculitis, observation risks permanent damage, and starting with outpatient oral steroids would delay needed therapy. Therefore, referring to the emergency department for blood work and IV methylprednisolone is the correct initial step.