Eyes: Central Retinal Artery Occlusion

Eyes: Central Retinal Artery Occlusion 2018-01-30T16:36:18+08:00

History

  • Sudden onset
  • Painless loss of vision

Relevant physical signs

  • Relative afferent pupillary defect
  • Fundoscopy
    • Usually develop after an hour
    • Resolves after 5 – 10 days
    • Characterized by
      • Pale, oedematous retina
      • Cherry red spot at the macula
  • Underlying cause
    • Pulse – atrial fibrillation
    • Carotid artery bruits
    • Cardiomegaly – intramural thrombus
    • Temporal artery tenderness – temporal arteritis

Causes

  • Hypercoagulable states
    • Antiphospholipid syndrome
    • Nephrotic syndrome
    • Factor V Leiden
    • Protein C deficiency
    • Protein S deficiency
    • Hyperhomocysteinaemia
    • Underlying malignancy
  • Embolic
    • Internal carotid artery stenosis
    • Mural thrombus – atrial fibrillation or cardiomyopathy
  • Inflammatory
    • Giant cell arteritis
    • Polyarteritis nodosa
    • Systemic lupus erythematosus
  • Hyperviscosity syndromes
    • Polycaethaemia
    • Chronic leukaemias
    • Waldenstrom’s macroglobulinaemia
    • Sickle cell anaemia

Investigations

  • Cardiovascular risk factors: HbA1c, lipid monitoring
  • Carotid artery Doppler
  • Trans-thoracic echocardiogram
  • Consider temporal artery biopsy to exclude temporal arteritis

Management

  • Ocular emergency
  • Conservative: ocular massage to restore blood flow
  • Treat underlying cause
    • Antiplatelets for secondary prevention
    • Anticoagulation for embolic stroke
    • Steroids for temporal arteritis
  • Consider intra-arterial thrombolytic therapy

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