Disease Profiles: Vascular Disease

Question 1

Name 3 factors which cause retinal vein occlusion

Answer 1

Virchow’s triad - endothelial damage e.g. diabetes, abnormal blood flow e.g. hypertension, hypercoaguable state e.g. cancer

Question 2

Describe the clinical presentation of retinal vein occlusion

Answer 2

Sudden painless loss of vision

Branch retinal vein occlusion may result in visual field defects corresponding to affected branch

Question 3

Describe the pathophysiology of retinal vein occlusion

Answer 3

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)

Question 4

Define central retinal artery occlusion

Answer 4

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

Question 5

Describe the clinical findings of branch retinal artery occlusion

Answer 5

Acute onset of painless, monocular visual impairment

The severity of visual loss depends upon the area of retinal tissue affected by the vascular occlusion

Question 6

Describe the fundoscopy findings seen in amaurosis fugax

Answer 6

Usually no abnormal findings

Question 7

Describe the fundoscopy findings seen in branch retinal artery occlusion

Answer 7

Absence of perfusion in the affected artery

Question 8

Describe the fundoscopy findings seen in vitreous haemorrhage

Answer 8

Visible haemorrhage

Question 9

What is the most common cause of retinal artery occlusion?

Answer 9

Arteriosclerosis-related thrombosis

Question 10

Describe the management of branch retinal artery occlusion

Answer 10

Referral to stroke clinic

Question 11

Define amaurosis fugax

Answer 11

Transient central retinal artery occlusion

Question 12

Describe the clinical presentation of central retinal artery occlusion

Answer 12

Sudden, painless severe loss of vision

Question 13

What causes the RAPD in a central retinal artery occlusion?

Answer 13

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

Question 14

What causes vitreous haemorrhage?

Answer 14

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

Question 15

Describe the fundoscopy findings seen in retinal vein occlusion

Answer 15

Flame and blot haemorrhages

Optic disc oedema

Macula oedema

Dilated tortuous veins

Question 16

Define branch retinal vein occlusion

Answer 16

Venous occlusion at any branch of the central retinal vein resulting in visual problems in the area drained by that branch

Question 17

Define vitreous haemorrhage

Answer 17

Bleeding in the vitreous cavity

Question 18

What causes the loss of red reflex in vitreous haemorrahge?

Answer 18

Vitreous hemorrhage can obstruct light from focusing on the retina

Question 19

Describe the fundoscopy findings seen in central retinal artery occlusion

Answer 19

Arteries become narrow (‘thread-like’)

Retina becomes pale, opaque and oedematous

Cherry-red spot is seen at the fovea

Question 20

Name an autoimmune disease which can cause central retinal artery occlusion

Answer 20

Giant cell arteritis - vasculitis affecting the ophthalmic or central retinal artery causes reduced blood flow

Question 21

What causes branch retinal artery occlusion?

Answer 21

Occurs when one of the branches of the central retinal artery becomes occluded, resulting in ischamic damage to the area the branch supplies

Question 22

Define central retinal vein occlusion

Answer 22

Occurs when a thrombus forms in the retinal veins and blocks the drainage of blood from the retina

Question 23

Describe the management of retinal vein occlusion

Answer 23

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

Question 24

Describe the management of central retinal artery occlusion

Answer 24

Immediate referral to stroke clinic

Question 25

Describe the management of vitreous haemorrhage

Answer 25

Treat underlying aetiology

Question 26

Describe the clinical presentation of amaurosis fugax

Answer 26

Transient painless visual loss

‘Like a curtain coming down’

Lasts ~5 mins with full recovery

Question 27

Define retinal vein occlusion

Answer 27

Occurs when a thrombus blocks a retinal vein

Question 28

Describe the clinical presentation of vitreous haemorrhage

Answer 28

Sudden, painless visual loss or haze

May describe new onset floaters

Question 29

Describe the management of amaurosis fugax

Answer 29

Refer to stroke clinic