Retina

Question 1

CRAO
Symptoms: Unilateral, painless vision loss and/or amaurosis fugax
Signs: Cherry spot red

Answer 1

Etiology: Embolus (Yellow: hollenhorst-cholesterol, white: calcium cardiac valves, white: platelet fibrins). Thrombus, GCA!
Treatment: refer to an internist or neurologist immediately for stroke management if embolus seen. Refer GCA suspect. Reduce pressure with AC paracentesis, 500 mg acetazolamide p.o. or ocular massage.
Follow up: As directed by internist. Return in 1-4 weeks to check for neo of disc, angle, etc that occurs in 20% of patients and perform PRP or anti-VEGF.

Question 2

Ocular Ischemic Syndrome:
Symptoms; Painful vision loss, amaurosis fugax, prolonged recovery of vision after exposure to bright light. Men 2:1 and 50-80 yo.
Signs: Although retinal veins are dilated and irregular in caliber, they are typically not tortuous. The retinal arterioles are narrowed. Associated findings include midperipheral retinal hemorrhages (80%), iris neovascularization (66%), and posterior segment neovascularization (37%). cotton–wool spots, spontaneous pulsations of the central retinal artery, and cherry-red spot. CRAO may occur.

Answer 2

Etiology: Carotid disease: Usually ≥90% stenosis.
Ophthalmic artery disease: Less common.
Treatment: Search carefully for NVI/NVA/NVD/NVE
Often unsuccessful.
Carotid endarterectomy for significant stenosis. Refer to neurovascular surgeon. Consider PRP and anti-VEGF agents in the presence of neovascularization.
Control HTN, diabetes, and cholesterol. Refer to internist.
Lifestyle modification (e.g., smoking cessation).