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Y3 - Opthalmology > Central retinal arterial occlusion > Flashcards

Central retinal arterial occlusion Flashcards

1
Q

Describe the pathophysiology of central retinal artery occlusion:

A

occlusion of the retinal artery results in hypoperfusion of the retina, hypoxic damage, retinal cell death and visual loss

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2
Q

What is the most common cause of central retinal artery occlusion?

A

embolism

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3
Q

Give 2 common origins of central retinal artery emboli:

A
  1. Carotid artery
  2. heart in AF
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4
Q

What is the second most common cause of central retinal artery occlusion?

A

in-situ thrombosis

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5
Q

What are 4 causes of in-situ retina artery thrombosis?

A
  1. Atherosclerotic disease
  2. Vasculitis
  3. Inflammatory disorders
  4. Hypercoagulable states
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6
Q

Give 7 risk factors for central retinal artery occlusion:

A
  1. Hyperlipidaemia
  2. Hypercoagulable states
  3. Hypertension
  4. Carotid artery stenosis
  5. Smoking
  6. Male
  7. diabetes
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7
Q

Give 6 chronic conditions that predispose to thrombosis:

A
  1. sickle cell anaemia
  2. multiple myeloma
  3. SLE
  4. Factor V leiden
  5. temporal/ giant cell arteritis
  6. anti-phospholipid syndrome
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8
Q

What is the characteristic presenting symptom associated with central retinal artery occlusion?

A

sudden, painless unilateral vision loss that occurs over second

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9
Q

What sign is seen when testing pupillary reflex in an eye affected by central retinal artery occlusion?

A

relative afferent pupillary defect

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10
Q

What fundoscopy sign is associated with central retinal artery occlusion?

A

pale retina with central cherry red spot

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11
Q

Why does the retina appear pale?

A

due to oedema

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12
Q

What causes the cherry red spot?

A

cherry-red spot is from the thin fovea revealing the preserved underlying choroidal circulation.

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13
Q

With central retinal artery occlusion being a clinical diagnosis, what two tests can be used if there is any doubts?

A
  1. Fluorescein angiography
  2. Optical coherence tomography
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14
Q

What is fluorescein angiography?

A

An eye test that involves injection of a fluorescent dye to examine blood flow.

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15
Q

What are 3 laboratory investigations indicated when central retinal artery occlusion is indicated?

A
  1. ESR and CRP to exclude temporal/giant cell arteritis
  2. FBC to check for anaemia and myeloproliferative disorders
  3. Coagulation studies to check for coagulation disorders
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16
Q

If an embolic cause is suspected, what 4 other investigations may be considered?

A
  1. Carotid duplex ultrasound (carotid artery stenosis)
  2. ECG (AF)
  3. Echocardiogram (mural thrombus)
  4. Ambulatory ECG monitoring (to look for paroxysmal atrial fibrillation)
17
Q

What drug is used in intra-arterial fibrinolysis of the retinal artery within 24 hours?

A

local injection of urokinase

18
Q

What class of drug is used for IV thrombolysis for central retinal artery occlusion?

A

tissue plasminogen activator

19
Q

Give an example of a tissue plasminogen activator (tPA)?

A

alteplase

20
Q

Give two clot busting techniques that can be used within the first 24 hours of central retinal artery occlusion:

A
  1. Intra-arterial fibrinolysis
  2. IV thrombolysis
21
Q

What are 2 non-clot busting techniques used to treat central retinal artery occlusion?

A
  1. Ocular massage
  2. Reduce intraocular pressure using IV acetazolamide and mannitol to increase retinal artery perfusion pressure
22
Q

What drug class should be given to vasculitis-associated central retinal artery occlusion?

A

high-dose steroids

23
Q

What is used to increase blood oxygen content and dilate retinal arteries?

A

administration of sublingual isosorbide dinitrate or oral pentoxifylline. Inhalation of a carbogen or hyperbaric oxygen

24
Q

Why does central retinal artery occlusion increase the risk of vitreous haemorrhage and neovascular glaucoma?

A

it causes neovascularisation in the weeks following the episode

25
Q

Give two complications of central retinal artery occlusion:

A

1) neovascular glaucoma
2) vitreous haemorrhage

26
Q

How long must ischaemia to the retina last in order to cause irreversible damage?

A

4 hours

Y3 - Opthalmology (14 decks)

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