retinal vascular occlusion

Question 1

how does this present?

Answer 1

Disorders of the retina can present acutely or chronically with visual loss or visual disturbances.

Question 2

how is it divided?

Answer 2

central vs branch

Question 3

central

Answer 3

Central
§ Complete visual loss
§ Usually preceded by amaurosis fugax TIA
§ Sudden onset

Question 4

branch

Answer 4

Sudden onset
§ Field loss
§ Branch of the central retinal artery
§ Usually preceded by TIA

Question 5

signs

Answer 5

Signs:
§ Pale retina
§ Cherry red spot centre in central retinal artery occlusion
§ RAPD present (please see skills handout)

Question 6

what must you ?

Answer 6

In elderly patients a history of headaches/temporal tenderness/jaw claudication must be elicited.
If presents within 3hrs of visual loss then prompt ocular massage and treatment with
acetazolamide must be given to ensure arterial perfusion is restored.

The role of the emergency physician is to make the appropriate differential diagnoses and
appropriate referral to the eye clinic. One of the main risk factors is age and smoking, and thus
its appropriate to elicit these in the history. Do remember that the signs and symptoms of giant
cell arteritis can masquerade as several different posterior segment problems and should be
considered in anyone over 65, particularly if other features of jaw claudication, temporal
headache and myalgia is present.

Question 7

Ix

Answer 7

Vasculopathic screen

§ Lipids, FBC, CRP, ESR,

Question 8

Mx

Answer 8

STAT aspirin 300mg
§ Refer to stroke clinic
§ ABCD2 score – crucial to assess risk of cerebral stroke

Question 9

venous occlusion

Answer 9

Venous occlusions of the retina are divided into central and branch retinal vein occlusions.
Both can present with sudden onset painless visual loss or field loss. The key is to elicit a
thorough history of vasculopathic risk facors.

Question 10

mx

Answer 10

Optimise vascular risk factors
§ Hypertension
§ Hypercholestrolaemia
§ Glycaemic control