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