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
Carotid endarterectomy if suitable (may worsen patients with rubeosis).
Medical therapy – BP, DM.
PRP – eyes with rubeosis/neovascularisation.
Anti-VEGF – macular oedema