Jekyll and Hide face

[Hobbitses]

I have GCA (stroke in optic nerve in 2016, right eye). The right side of my face is now noticeably wrinklier than the other - am I right in supposing it could be due to the temporal arteries on that side not functioning…? or maybe it’s just the way it goes!

[PMRpro Ambassador]

Did you have a temporal artery biopsy that removed the artery? Shouldn't usually be a problem as there are loads of other arteries in the scalp and face to take over the blood flow and the body actually grows new arteries if needed.

The bone structure in everyone's face is assymetric even if it isn't obvious at first glance. Skin elasticity changes with age and becomes less resilient to stretching or sagging. This can result in one side of the face appearing more wrinkled or droopy than the other if the bones underneath are very different.

[Hobbitses in reply to PMRpro]

Thanks Pro - yes, temporal biopsy. Just trying to find a reason, other than the usual ravages of time and always sleeping on that side! Tried satin pillow too… ☹️

[PMRpro Ambassador in reply to Hobbitses]

Sorry - but it is what it is, whatever the source ... Sleep sitting up????? 😴

[Hobbitses]

🤣

[harpsichor]

You could try a Tua Viso machine - these are a very easy way of building up the facial muscles. They have been used in helping people with Bell’s Palsy to recover. They work by stimulating the muscles with a mild electric current. I have used one for several years and a friend recently told me she had bought a reconditioned one on eBay for £50.

[Hobbitses in reply to harpsichor]

Never heard of that - thanks v much, will investigate.

[pats000paints]

The right hand side? Are you a driver? Those who drive a lot are exposed to more sun on that side in a vehicle even in our climate. It's noticable often in bus and lorry drivers. Even through glass, the sun's rays can cause damage.

[Hobbitses in reply to pats000paints]

Not a driver since GCA sight loss eight years ago… but a good point.

[AtopicGuy in reply to Hobbitses]

It's a good hypothesis, because long-term exposure to UV destroys collagen and elastin in the skin. And that makes me wonder whether you have been treated on one side with medications that may do something similar.

[Joanne8 in reply to Hobbitses]

Hi, hope you can help. I am awaiting for the results of a recent MRI, eye tests have shown considerable loss of peripheral vision in one eye and the OCT scan showed thinness of the ganglion cell layer. I have another autoimmune disease so think this could be GCA. Can I ask is this condition treated by Rheumatology or the Eye Clinic at the hospital? Can I ask did you lose all the sight in your eye at once or was this a gradual thing? The optometrist thought that I had suffered a TIA. I had an episode where I had several floaters in the eye approx 3 years ago. I went immediately to the Opticians and paid for an OCT scan but they couldn’t find anything wrong and said that floaters were normal. They did not do a peripheral test at the time. Did the GCA show up on an MRI or by biopsy? I am desperately wondered after reading all these posts.

[PMRpro Ambassador in reply to Joanne8]

In GCA the loss of sight is usually a quite sudden event although it may be preceded by warning fleeting visual effects that come and go - called amaurosis fugax. Once such visual effects appear, it is said you have about a week in which to start treatment to avoid permanent visual loss, partial or total. GCA is effectively a stroke - loss of blood supply to a specific nerve, the optic nerve, and damage that can be irreversible if the cause isn't reversed. So the amaurosis fugax is like a TIA, permanent loss is a full blown stroke.

There are various causes of loss of peripheral vision - one is persistent raised occular pressures, the pressure in the eyeball. DId the optometrist check eye pressures - they seem a bit dilatory not to have checked peripheral vision, my optician in Scotland ALWAYS checked it. If the optometrist thought you had had a TIA - were you not referred to the stroke clinic for further investigations? You should have been as a TIA can be a warning that something is present that could cause a stroke - but if treated won't.

GCA is normally managed by rheumatology but when it present with visual loss then eye specialists are often involved - DorsetLady can tell you more about that.

What you are describing isn't a typical presentation for GCA, especially as you don't mention any other symptoms. It is more typical of other causes of loss of peripheral vision. Once you have the results of the MRI they will know more though I don't know if the MRI would flag up GCA. But if you are under the Eye Clinic - they are more than capable of diagnosing and managing GCA as well as any other potential causes. You don't say anywhere how old you are - that is also relevant as although GCA can occur in younger patients, it is much less common under the age of 50.

[Joanne8 in reply to PMRpro]

Thank you for your detailed response, very much appreciated. I see the Eye Doctor in two weeks to review the MRI but I am going to ask my GP to do a referral to a Rheumatologist as there are a few things that are pointing to GCA. Prior to the floater episode I had a painful shoulder that took several months to heal. I also had to visit the dentist with what I thought was a tooth infection but the pain was definitely in the jaw on the same side as the affected eye. The headaches I get are in the temple area of the affected eye. I don’t know how early onset GCA presents but I think I definitely need to rule it out.

[PMRpro Ambassador in reply to Joanne8]

Could take MONTHS in the current climate!! I would tell the eye doctors about the potential other symptoms. It is unusual for GCA/PMR to come and go in that way but nothing is impossible.

[DorsetLady PMRGCAuk volunteer in reply to Joanne8]

My started on shoulders -which is why GP misdiagnosed me as frozen shoulder. And from then on attributing all pains in neck/head to that. Fatigue was attributed to age (63) and being a carer for late hubby. 🤦🏻‍♀️

[DorsetLady PMRGCAuk volunteer in reply to Joanne8]

Suggest you get to local optician and say you are concerned about GCA so would like an examination to ascertain what is going on.

My sight loss was not a one minute it's there, next it's not - it deteriorated over a few days.

Initially slight blurring in evening at bottom right-hand corner, though I'd got grit in it, been out that day, windy and dust flying all over the place. So usual procedure, rinsing it etc.. same next day, following day appointment with GP to check if connected to misdiagnosed aches and pains I had, told emphatically No! 3rd day got slowly worse as day progressed, 4th day [Saturday] woke up in morning - eye completely blurred, so rang my local optician, told to go to A&E - which I did, GCA diagnosed within the hour by on call ophthalmologist - 80mg Pred started - unfortunately that eye couldn't be saved, but other one was.

Was under ophthalmologist and Eye Department for first few months.. in fact didn't have an appointment with rheumy until 7 months later.

Others have had moments/minutes of complete sight loss, other strange disturbances, some resulting in sight loss, other not as treated in time.

[Joanne8 in reply to DorsetLady]

Thank you for your reply, very much appreciated.

[Hobbitses in reply to Joanne8]

Hi Joanne8 - to answer your Qs in order: I am under both Rheumatology and hospital Eye Clinic. First sign of something wrong was a very definite dark shape in my vision (right eye) when I glanced out of a window at a bright blue sky - nothing like a floater, which I also have. I went straight to A&E (first day of Junior Doc strike) and was given a tube of cream for a ‘scratched cornea’.

Not happy, I booked an appointment with an optician three days after this. He took a photo of the back of my eye which showed a ‘pale disc’ and he referred me immediately to Moorfields at St George’s hospital where I spent 13 hours. They put me on a v high dose of steroids. Later my GP referred me to a private consultant who broke the news I’d had a stroke in the optic nerve and was not likely to get the sight back. Vision worsened gradually over days/weeks (can’t really remember) and then, as now, I was left with about 50% vision in that eye.

To note: I had had a temporal artery biopsy 6 months before this because of jaw claudication, which my GP identified as a symptom of GCA and immediately increased my Pred dose from 5mg to 60mg to save my sight. It’s possible I was told to decrease my Pred dose maybe too quickly after that…?

Don’t know if any of this helps but all the best…

[Joanne8 in reply to Hobbitses]

That is really helpful thank you. According to the OCT the pallor at the back of the eye is not pale. I am not sure if that is a good thing or not. The Optometrist was of the opinion I have had a TIA as there is definitely a blind spot. The detailed peripheral vision test showed there were a lot of targets missed at the edges of the affected eye. I have had other symptoms such as jaw pain, eye pain in the temple area and an unexplained shoulder injury. I am seeing the Eye Doctor in two weeks so hopefully will get some answers then. I am going to ask my GP to refer me to a Rheumatologist just to be on the safe side. My mother lost most of her vision due to Uveitis which is another Autoimmune disease.

[Hobbitses in reply to Joanne8]

I didn’t add this just now because I felt I’d blurthered on long enough, but I had a TIA since then - in my left eye. I noticed a tiny bit missing in my vision one day (wrote something down, looked back at what I’d written and thought that’s funny I was sure I’d dotted that i - when I looked again I realised I had, but hadn’t seen it the first time...). Eye clinic couldn’t see anything but when the v bright light shone in my left eye I saw a tiny shape (paranoid about such things now) that was the culprit. There was some argument between Rheumie and Stroke clinic but the conclusion was TIA not GCA so I’m now on blood thinners. It hasn’t affected my vision in that eye.

Headaches and jaw pain on the affected side a bit worrying , although GCA jaw pain only supposed to happen WHILE chewing…

[AtopicGuy]

If the "stroke" restricted blood to the optic nerve on the righthand side, perhaps it also affected minor nerves nearby? People who have Botox injections to reduce 'crow's feet' wrinkles near the eyes are, in fact, paralysing nerves that control muscles just under the skin, so there is a link.