Retinal Artery Occlusion

Central retinal artery – majority of inner retina blood circulation.

Cilioretinal artery – 15-30% of the circulation. (cilioretinal artery occlusion happens about 5% cases – watch out for GCA).

Branch retinal artery occlusion (BRAO):

  • 40% of cases.

  • Retinal emboli is the cause.

  • Painless loss of vision – 3/4 has 6/12 vision or better.

  • Sectoral retinal opacification with retinal oedema.

  • Monitor for iris neovacularisation (rare).

Central retinal artery occlusion (CRAO):

  • Elderly male.

  • Bilateral cases 1-2%.

  • Sudden painless loss of vision +/- amaurosis fugax.

  • RAPD present

  • Rubeosis usually within 4-5 weeks (20% cases).

  • Cherry red spot at fovea (cilioretinal artery patent), retinal whitening, arterial attenuation, cattle tracking (emboli), ONH oedema (think of AION).

Management:

  1. Rule out GCA – FBC / ESR / CRP / Temporal artery biopsy / steroids Rx.

  2. Carotid Doppler USS

  3. Referral to TIA clinic

  4. Young patients – hypercoagulable cause – blood test for homocysteine, sickle cell, Factor V Leiden, protein C & S, antithrombin III and antiphospholipid antibody.

  5. Conservative treatment

  6. Active treatment – window of 4 hours (irreversible damage after onset – retina can withstand ischaemia without damage up to 97 minutes after onset of CRAO) – ocular massage or AC paracentesis to dislodge emboli.

 
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