Ocular Ischaemic Syndrome

Usually males in 60s and unilateral.

Secondary to carotid artery obstruction – atherosclerosis related (DM, HTN). Other causes are GCA, trauma, dissecting aneurysm or inflammation.


Symptoms: gradual reduction in vision with pain. May have history of amaurosis fugax.


Signs: iris neovascularisation, AC reaction, occasional IOP rise, retinal arteries attenuation with dilated nontortuous retinal veins, retinal haemorrhages, disc or retinal neovascularisation.


Investigations: FFA – delayed filling of veins (main finding).


Differential to think of: GCA and CRVO


Treatment:

  1. Carotid endarterectomy if suitable (may worsen patients with rubeosis).

  2. Medical therapy – BP, DM.

  3. PRP – eyes with rubeosis/neovascularisation.

  4. Anti-VEGF – macular oedema

 
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