Central retinal artery occlusion: Difference between revisions

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==Background==
==Background==
*Internal carotid -> ophthalmic -> central retinal artery
*Cherry red spot (fundoscopy)
**Macula is thinnest portion of retina
**Intact underlying choroidal circulation remains visible through this section
***Macular area maintains normal color (red) versus surrounding ischemic, pale retina
*Restoration of blood flow within 100min may lead to complete recovery
**Occlusion >240min leads to irreversible damage
===Etiology===
===Etiology===
#Retinal Embolism (20%)
#Embolism
#Atherosclerotic changes
#Thrombosis
#Angiospasm
#Giant cell arteritis
#Inflammatory Endarteritis
#Vasculitis
#Sickle cell
#Trauma
#Vasospasm (migraine)
#Glaucoma
#Low retinal blood flow (carotid stenosis or hypotension)


===Epidemiology===
==Clinical Features==
#Bilateral 1-2%
#Sudden, painless, monocular vision loss
#M>F
##Often preceded by episodes of amaurosis fugax


==Symptoms==
==Diagnosis==
Painless, monocular loss of vision
#APD
#Fundoscopy
##Pale retina, cherry red macula
##Boxcar segmentation of blood column


==DDx==
==DDx==
#Amaurosis fugax (painless, fleeting; nl exam)
#Amaurosis fugax
#CRVO (painless, over hours; blood and thunder)
#CRVO
#Temporal Arteritis
#Temporal Arteritis
#Acute glaucoma (blurry vision, eye pain)
#Acute glaucoma
 
==Exam==
#Pale retina with edema
#Cherry red spot at the macula
#APD
#Boxcar segmentation of blood column
 
==Workup==
#Fundoscopic exam
#CBC, ESR, EKG


==Treatment==
==Treatment==
# Ocular massage
#Consult ophtho
# Anterior chamber paracentesis
#No evidence supporting or refuting the following treatments:
# Intraarterial fibrinolysis
##Ocular massage
# Acetazolamide
###Apply intermittent pressure to create pressure gradient to dislodge embolism
# Mannitol
#Anterior chamber paracentesis
# Timolol
##Causes acute drop in IOP to dislodge embolism
# Steroids
#Intraarterial fibrinolysis
# Hyperbarics (most effective if within 2-12h of presentation)
#Acetazolamide
#Mannitol


==Dispo==
==Dispo==
Admit: comorbid disease
*D/c w/ ophtho f/u in 1-4wk
 
D/C: f/u with ophtho in 1-4 weeks


==Source==
==Source==
H-N
*Tintinalli
 
*UpToDate
[[Category:Ophtho]]
[[Category:Ophtho]]

Revision as of 20:52, 28 October 2011

Background

  • Internal carotid -> ophthalmic -> central retinal artery
  • Cherry red spot (fundoscopy)
    • Macula is thinnest portion of retina
    • Intact underlying choroidal circulation remains visible through this section
      • Macular area maintains normal color (red) versus surrounding ischemic, pale retina
  • Restoration of blood flow within 100min may lead to complete recovery
    • Occlusion >240min leads to irreversible damage

Etiology

  1. Embolism
  2. Thrombosis
  3. Giant cell arteritis
  4. Vasculitis
  5. Sickle cell
  6. Trauma
  7. Vasospasm (migraine)
  8. Glaucoma
  9. Low retinal blood flow (carotid stenosis or hypotension)

Clinical Features

  1. Sudden, painless, monocular vision loss
    1. Often preceded by episodes of amaurosis fugax

Diagnosis

  1. APD
  2. Fundoscopy
    1. Pale retina, cherry red macula
    2. Boxcar segmentation of blood column

DDx

  1. Amaurosis fugax
  2. CRVO
  3. Temporal Arteritis
  4. Acute glaucoma

Treatment

  1. Consult ophtho
  2. No evidence supporting or refuting the following treatments:
    1. Ocular massage
      1. Apply intermittent pressure to create pressure gradient to dislodge embolism
  3. Anterior chamber paracentesis
    1. Causes acute drop in IOP to dislodge embolism
  4. Intraarterial fibrinolysis
  5. Acetazolamide
  6. Mannitol

Dispo

  • D/c w/ ophtho f/u in 1-4wk

Source

  • Tintinalli
  • UpToDate
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