#34. Acute retinal arterial and venous occlusive disease (branch and central retinal artery and vein occlusion).

Question 1

What is ACUTE Retinal ARTERIAL OCCLUSIVE Disease?

Answer 1

OBSTRUCTION to ARTERIAL Circulation of the RETINA

Question 2

What is the CAUSE of ACUTE Retinal ARTERIAL OCCLUSIVE Disease?

Answer 2

• DUE to an EMBOLUS / THROMBUS
• ALONG with SPASM of Artery
• Occurs in
  a. Hypertension
  b. Arteriosclerosis / Atherosclerosis
  c. Temporary Arteritis
  d. Buerger’s Disease

Question 3

What is the PATHOGENESIS of ACUTE Retinal ARTERIAL OCCLUSIVE Disease?

Answer 3

Arterial ISCHAEMIA results in

1) INFARCTION of INNER 2/3 of RETINA

2) REFLEX CONSTRICTION of WHOLE Retinal Arterial BVs

3) STASIS of Retinal CAPILLARIES

Question 4

Where does ARTERIAL OCCLUSIVE Disease occur in the Retina?

Answer 4

1) CENTRAL RETINAL ARTERY
- At the LAMINA CRIBROSA
- Entire Retina is affected
- Occurs at the BIFURCATION

2) PERIPHERAL BRANCH
- The SUPERIOR TEMPORAL Branch is affected the most

• The DISTAL AREA of the Retina that’s supplied by the vessel BECOMES OEDEMATOUS

Question 5

What are the SYMPTOMS of ARTERIAL OCCLUSIVE DISEASE of the RETINA?

Answer 5

• Sudden / Complete / Permanent LOSS of Vision
• Sometimes CENTRAL VISION can persist = DUE to CILIORETINAL ARTERY that SUPPLIES the MACULAR AREA
• AMAUROSIS FUGAX = Where there’s SUDDEN LOSS of Vision at first, and THEN RECOVERS due to DISLODGEMENT of EMBOLUS in Peripheral Arterioles

Question 6

What are the SIGNS of ARTERIAL OCCLUSIVE DISEASE of the RETINA?

Answer 6

1) FUNDUS EXAMINATION
- Arteries are very thin + not visible
- Retina is Opaque / Milky White
- CHERRY RED SPOT is seen at FOVEA CENTRALIS
- OPTIC DISC is PALE due to Ischaemia

2) PUPIL
- Widely DILATED
- NO REACTION to Light

Question 7

What is the DIFFERENTIAL DIAGNOSIS to ARTERIAL OCCLUSIVE DISEASE of the RETINA?

Answer 7

• Tay-Sachs Disease
• Niemann-Pick Disease
• Myoclonus
• Berlin’s Oedema
• Macular Hole / Haemorrhage

Question 8

What is the TREATMENT for ARTERIAL OCCLUSIVE DISEASE of the RETINA?

Answer 8

• RELIEVE Spasm
• REMOVE Embolus into a Peripheral Branch of Central Retinal Artery
• VASODILATORS = Inject Acetylcholine in TENON’s CAPSULE
• Massage GLOBE with IV ACETAZOLAMIDE

Question 9

What is ACUTE Retinal VENOUS OCCLUSIVE Disease?

Answer 9

OBSTRUCTION to VENOUS Circulation of the RETINA

Question 10

What is the CAUSE of ACUTE Retinal VENOUS OCCLUSIVE Disease?

Answer 10

• DUE to an EMBOLUS / THROMBUS
• Occurs in ELDERLY
  a. Hypertension
  b. Arteriosclerosis / Atherosclerosis
  c. Diabetes
• CHRONIC Open-Angle Glaucoma

Question 11

What is the PATHOGENESIS of ACUTE Retinal VENOUS OCCLUSIVE Disease?

Answer 11

1) OBSTRUCTION of Blood OUTFLOW / STAGNATION

2) INCREASED Intravascular Pressure

3) Leading to Retinal OEDEMA / ABNORMAL Leakage / Haemorrhage

4) FORMING Collaterals + Neovascularisation

Question 12

Where does VENOUS OCCLUSIVE Disease occur in the Retina?

Answer 12

• BEHIND the LAMINA CRIBROSA (Artery / Vein share a common sheath)

Question 13

What are the SYMPTOMS of VENOUS OCCLUSIVE DISEASE of the RETINA?

Answer 13

• SUDDEN Onset of IMPAIRED Vision
• NOT AS SUDDEN in Central Retinal Artery Occlusion

Question 14

What are the SIGNS of VENOUS OCCLUSIVE DISEASE of the RETINA?

Answer 14

• TORTUOUS Retinal Veins
• Retina is covered with MULTIPLE EXTENSIVE Haemorrhages
• Cotton-Wool EXUDATES
• Neovascularisation
• Retina becomes ATROPHIC

Question 15

What is the TREATMENT for VENOUS OCCLUSIVE DISEASE of the RETINA?

Answer 15

• Anticoagulants
• Steroids
• PANPHOTOCOAGULATION of Retina
• CRYOAPPLICATION