Disease Profiles: Vascular Disease Flashcards
Name 3 factors which cause retinal vein occlusion
Virchow’s triad - endothelial damage e.g. diabetes, abnormal blood flow e.g. hypertension, hypercoaguable state e.g. cancer
Describe the clinical presentation of retinal vein occlusion
Sudden painless loss of vision
Branch retinal vein occlusion may result in visual field defects corresponding to affected branch
Describe the pathophysiology of retinal vein occlusion
Blockage of a retinal vein causes pooling of blood in the retina, resulting in leakage of fluid and blood causing macular oedema and retinal haemorrhages
This results in damage to the tissue in the retina and loss of vision
It also leads to the release of VEGF, which stimulates the development of new blood vessels (neovascularisation)
Define central retinal artery occlusion
Occlusion of the central retinal artery, with resultant infarction of the inner 2/3 of the retina (outer 1/3 is supplied by choroid) and vision loss
Describe the clinical findings of branch retinal artery occlusion
Acute onset of painless, monocular visual impairment
The severity of visual loss depends upon the area of retinal tissue affected by the vascular occlusion
Describe the fundoscopy findings seen in amaurosis fugax
Usually no abnormal findings
Describe the fundoscopy findings seen in branch retinal artery occlusion
Absence of perfusion in the affected artery
Describe the fundoscopy findings seen in vitreous haemorrhage
Visible haemorrhage
What is the most common cause of retinal artery occlusion?
Arteriosclerosis-related thrombosis
Describe the management of branch retinal artery occlusion
Referral to stroke clinic
Define amaurosis fugax
Transient central retinal artery occlusion
Describe the clinical presentation of central retinal artery occlusion
Sudden, painless severe loss of vision
What causes the RAPD in a central retinal artery occlusion?
Occurs because the input is not being sensed by the ischaemic retina when testing the direct light reflex but is being sensed by the normal retina during the consensual light reflex
What causes vitreous haemorrhage?
Rupture of normal vessels from mechanical force e.g. trauma, retinal tear/PVD
Haemorrhage from pathological structures e.g. rupture of retinal neovascularization from diabetic retinopathy or retinal vein occlussion
Describe the fundoscopy findings seen in retinal vein occlusion
Flame and blot haemorrhages
Optic disc oedema
Macula oedema
Dilated tortuous veins
Define branch retinal vein occlusion
Venous occlusion at any branch of the central retinal vein resulting in visual problems in the area drained by that branch
Define vitreous haemorrhage
Bleeding in the vitreous cavity
What causes the loss of red reflex in vitreous haemorrahge?
Vitreous hemorrhage can obstruct light from focusing on the retina
Describe the fundoscopy findings seen in central retinal artery occlusion
Arteries become narrow (‘thread-like’)
Retina becomes pale, opaque and oedematous
Cherry-red spot is seen at the fovea
Name an autoimmune disease which can cause central retinal artery occlusion
Giant cell arteritis - vasculitis affecting the ophthalmic or central retinal artery causes reduced blood flow
What causes branch retinal artery occlusion?
Occurs when one of the branches of the central retinal artery becomes occluded, resulting in ischamic damage to the area the branch supplies
Define central retinal vein occlusion
Occurs when a thrombus forms in the retinal veins and blocks the drainage of blood from the retina
Describe the management of retinal vein occlusion
Immediate referral to opthalmology
Management in secondary care aims to treat macular oedema and prevent complications such as neovascularisation - laser photocoagulation, intravitreal steroids, anti-VEGF
Describe the management of central retinal artery occlusion
Immediate referral to stroke clinic
Describe the management of vitreous haemorrhage
Treat underlying aetiology
Describe the clinical presentation of amaurosis fugax
Transient painless visual loss
‘Like a curtain coming down’
Lasts ~5 mins with full recovery
Define retinal vein occlusion
Occurs when a thrombus blocks a retinal vein
Describe the clinical presentation of vitreous haemorrhage
Sudden, painless visual loss or haze
May describe new onset floaters
Describe the management of amaurosis fugax
Refer to stroke clinic
