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Year 4 - Neurology and Special Senses > Ophthalmology - Central Retinal Artery Occlusion > Flashcards

Ophthalmology - Central Retinal Artery Occlusion Flashcards

1
Q

What is central retinal artery occlusion?

A

Obstruction to blood flow through the central retinal artery

The CRA is a branch of the ophthalmic artery which is a branch of the internal carotid

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2
Q

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

A

Atherosclerosis

Can also be caused by Giant cell arteritis, vasculitis affects the ophthalmic or CRA reducing blood flow

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3
Q

What are risk factors for atherosclerosis?

A
  • Smoking
  • Hypertension
  • Diabetes
  • Raised cholesterol
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4
Q

What are the risk factors for giant cell arteritis?

A
  • White
  • Older age
  • Female
  • Polymyalgia rheumatica
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5
Q

What is a common presentation of central retinal artery occlusion?

A

Sudden painless loss of vision

Curtain coming-down over vision

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6
Q

What is a relative afferent pupillary defect?

A

The pupil in the affected eye constricts more when light is shone in the other eye than in the affected eye

Input not sensed by ischaemic retina when testing direct light reflex sensed during consensual light reflex

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7
Q

What will fundoscopy show in a case of central retinal artery occlusion?

A
  • Pale retina
  • Cherry red spot
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8
Q

What causes the pale retina in central retinal artery occlusion?

A

Lack of perfusion

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9
Q

What does the cherry red spot represent in central retinal artery occlusion?

A

The fovea, which has a thinner surface showing the red-coloured choroid below

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10
Q

What are the key differentials for sudden painless vision loss?

A
  • Retinal detachment
  • Central retinal artery occlusion
  • Central retinal vein occlusion
  • Vitreous haemorrhage
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11
Q

What is amaurosis fugax?

A

A temporary loss of vision caused by a temporary interruption to the blood supply

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12
Q

What should be done in suspected cases of central retinal artery occlusion?

A

Refer immediately

Vision-threatening emergency

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13
Q

What testing is included for giant cell arteritis?

A
  • ESR blood test
  • Temporal artery biopsy
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14
Q

What is the treatment for giant cell arteritis?

A

High-dose systemic steroids

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15
Q

What are some immediate management options for central retinal artery occlusion?

A
  • Ocular massage
  • Anterior chamber paracentesis
  • Inhaled carbogen (5% CO2 and 95% oxygen) - dilates the artery
  • Sublingual isosorbide dinitrate
  • Oral pentoxifylline - dilate the artery
  • Intravenous acetazolamide - Reduces aqeuous humour production, reducing IO pressure
  • Intravenous mannitol
  • Topical timolol
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16
Q

What is the goal of long-term management for central retinal artery occlusion?

A

Treat reversible risk factors and secondary prevention of cardiovascular disease

Year 4 - Neurology and Special Senses (41 decks)

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