Occlusive vascular diseases Flashcards
what are the symptoms of occlusive vascular disease
unilateral (rarely bilateral), sudden, painless loss of vision affecting the elderly (not exclusively)
what may go unnoticed by an elderly patient with an occlusive vascular disease
sudden loss of vision
the occlusions of which vessels of the eye can cause occlusive vascular disease
- central retinal artery
- central retinal vein
- branches of the central retinal artery or vein
- cilio retinal artery
what can be the causes of occlusive vascular disease
- hypertension Grade 4
- other diseases
what can be the causes of occlusive vascular disease
- hypertension Grade 4
- other diseases
what causes amaurosis fugax
transient obscuration of retinal artery by embolus as it shifts (transient ischaemic attack TIA)
how long does a transient ischaemic attack last
list the symptoms of a transient ischaemic attack/amaurosis fugax
- sudden monocular loss of vision
- painless
- ‘like a blind coming down’
- clears slowly in reverse direction
- repetitive
what will be a optometric management of a transient ischaemic attack
refer to GP urgently after excluding GCA
what may the GP put a patient whose has a transient ischaemic attack on
aspirin
what are the 6 early signs of a central retinal artery occlusion
•Visual acuity – CF to LP
➢Exception cilio-retinal artery (25%)
- Pale oedematous retina – especially at the posterior pole
- Cherry red spot at macula – nerve fibre layer @ fovea & choroidal circulation showing through
- Arterial – attenuation (thinning), segmentation (beeding)
- Emboli may be seen in arteries
- RAPD – pupillary defect
what are the 3 late signs of a central retinal artery occlusion
- Optic disc atrophy – becomes purple/white over period of time
- Arterial attenuation and segmentation continues
- Visual acuity usually remains markedly reduced despite treatment
what are the symptoms of a central retinal artery occlusion
- Sudden, painless profound loss of vision – like a curtain coming down in vision
- May be preceded by transient obscuration’s of vision – amaurosis fugax
what are the symptoms of a central retinal artery occlusion
- Sudden, painless profound loss of vision – like a curtain coming down in vision
- May be preceded by transient obscuration’s of vision – amaurosis fugax
list the aetiologies of a central retinal artery occlusion
- Embolus>Thrombus (more likely to result from embolus)
- Thrombus (stenosis of carotid artery) – unlikely to respond to treatment & wont dislodge, so only treat if assumed to be due to an embolus
•Embolus – are bright and shiny but flat so blood can glow above & below it, 3 types:
➢Cholesterol crystals from carotid arteries
➢Platelet – fibrin emboli arising from large vessel stenosis (hardening of arteries)
➢Calcific emboli arising from carotid valve stenosis
list the risk factors of a central retinal artery occlusion
- Systemic hypertension
- Diabetes mellitus
- Hyperlipidemia
- Carotid artery disease
- Coronary artery disease
- TIA/CVA
- Giant cell arteritis
- Tobacco smoking
list the optometric managements of a central retinal artery occlusion
- Measure visual acuity
- Check pupils
- Urgent referral to eye casualty – is
list the ophthalmological management of a central retinal artery occlusion
•Reduce IOP – by reducing aqueous humour
➢Anterior chamber paracentesis
➢Intravenous acetazolamide and ocular massage – reduce production of aqueous
•Dilation of arteries
➢Ocular massage
➢Retrobulbar vasodilator drugs
➢Inhalation of carbogen
- Lysing of embolus/thrombus – to break up embolus/thrombus
- Systemic anticoagulants – if it’s a thrombus
•INVESTIGATION OF CAUSE
➢Increased mortality with presence of emboli
what is the epidemiology of a central retinal artery occlusion
- Onset mid-sixties
- Male to female ratio 2:1
- Rare (incidence 1.9 in 100,000 in U.S.)
what is the epidiomology of a central retina vein occlusion
- More commonly affect older people in their mid-sixties, but can also occur in younger patients
- Male to female ratio equal 5.2 in 1,000
what is the epidemology of a central retina vein occlusion
- More commonly affect older people in their mid-sixties, but can also occur in younger patients
- Male to female ratio equal 5.2 in 1,000
what is the epidemiology of a central retina vein occlusion
- More commonly affect older people in their mid-sixties, but can also occur in younger patients
- Male to female ratio equal 5.2 in 1,000
