retina Flashcards
what are the risk factors for retinal vein occlusion
2nd commonest retinal vascular disease after diabetic retinopathy
Risk factors
Age (main RF)
Cardiovascular disease – hypertension, hyperlipidaemia
Diabetes
Oral contraceptive pill
Haematological disorders (e.g. antiphospholipid syndrome)
Typically presents with sudden painless drop in vision +/- metamorphopsia (distortion)
what does vein occlusion look like on fundus
lots of red spots
what is the management for retinal vein occlusion
Assess for cardiovascular risk factors (BP, bloods – ESR, lipids, glucose, ECG)
In some patients (esp. if <50), consider further investigations
CXR – sarcoidosis, TB
Thrombophilia screen
Autoantibodies – rheumatoid factor, ANA
Assess for signs of retinal ischaemia
Neovascularisation (at disc/iris/elsewhere)
Cotton wool spots
Fluorescein angiography is usually diagnostic
how to differenitate between ishacemic and non isachameic CRVO
RAPD usually present in ischameic CRVO NOT IN non ishameic
no vf defect in non ishacmeic CRVO
fundus appaeraxne in non ishacemic crvo = haemhorhhage , cotton wool spots
more disc/macular edema in isachemic CRVO
normal ERG in non -ischameic
less chance of anterior segemtn in neovasuclarisation in non isahemic in CRVO
macular odema
Commonest cause for persistent poor VA in vein occlusion
Treated with anti-VEGF
If poor response, may consider intravitreal dexamethasone implant (Ozurdex)
Occasionally combined with laser
what are causes of retinal artery occlusion
Blood supply
Outer retina – ciliary arteries (choriocapillaris)
Inner retina – central retinal artery
Retinal artery occlusion – causes
Atherosclerosis (commonest)
Need to exclude GCA
Other inflammatory conditions – e.g. SLE, GPA, PAN (vasculitides)
asscesment of retinal artery occlusion
Cardiovascular assessment
Treat as a STROKE
Exclude GCA
Carotid ultrasound
Ocular massage
AC paracentesis
Mannitol
However no solid evidence for benefit and not always effective
