Central Retinal Artery Occlusion and Retinal Vein Occlusion

Question 1

Is central retinal artery or vein occlusion more common?

Answer 1

Retinal vein occlusion

Question 2

Describe the visual loss in central retinal artery occlusion

Answer 2

Dramatic visual loss within seconds of occlusion
In 90%, acuity is finger counting or worse
Painless
Unilateral

Question 3

What is the implication of retinal arteries being end arteries?

Answer 3

If there is obstruction there will be insufficient anastomotic supply for tissue survival

Question 4

In central retinal artery occlusion, after what time are changes irreversible?

Answer 4

1-2 hours

Question 5

Is central retinal artery occlusion considered a form of stroke?

Answer 5

Yes and should be managed the same

Question 6

How does the retina appear in retinal artery occlusion?

Answer 6

Pale
Oedematous
Fovea retains red colour due to being supplied by the choriocapillaris (cherry red spot)
Severe retinal haemorrhages

Question 7

What can cause central retinal artery occlusion?

Answer 7

Arterial embolus from carotid artery atherosclerosis, valvular heart disease, AF
Temporal Arteritis
Vasculitis
Atherosclerotic process (diabetes, HTN)

Consider all causes of a stroke

Question 8

What should you check during examination to determine possible cause of central retinal artery occlusion?

Answer 8

BP
HR- AF
Carotids - bruit
Heart - murmur

Question 9

When doing bloods why should you check ESR?

Answer 9

Will be high if temporal Arteritis is cause

Question 10

Describe management of central retinal artery occlusion

Answer 10

Ocular massage - help dislodge embolus
Surgical removal of aqueous or intraocular hypotensive treatment to reduce IOP
E.g IV acetazolamide to help rapidly reduce globe pressure

Question 11

Can the patient get afferent pupillary defect in central retinal artery occlusion?

Answer 11

Yes