Retinal Vascular Occlusions

Question 1

What are the consequences of ischaemic central retinal vein occlusion?

Answer 1

If sever ischaemic then:

• neovascular granuloma
• painful blind eye

Question 2

Who does retinal vein occlusion usually occur in?

Answer 2

over 65yrs

Question 3

What causes retinal vein occlusions?

Answer 3

• thrombus (most common)
• disease of the vein wall
• External compression e.g. by retinal artery

Question 4

What are the risk factors for retinal vein occlusion?

Answer 4

• age
• hypertension
• raised intraocular pressure
• inflammatory disease e.g. sarcoidosis
• thrombophilic disorders

Question 5

What are the symptoms of retinal vein occlusion?

Answer 5

sudden unilateral painless loss of vision or blurred vision (often occurs when waking up)

Question 6

What are the signs of retinal vein occlusion?

Answer 6

• mild or absent pupillary defect

- widespread dot blot haemorrhages and flame haemorrhages

Question 7

What are the differentials for retinal vein occlusion?

Answer 7

• Diabetic retinopathy
• open angle glaucoma
• stroke
• refractive error
• ocular ischemic syndrome

Question 8

What is the treatment for retinal vein occlusion?

Answer 8

Manage modifieable risk factors e.g. lower BP, control diabetes,

• reduce raised intraocular pressure
• intravitreal anti-VEGF agents

Question 9

What are the complications for retinal artery occlusion?

Answer 9

• hypoxia of inner retina

Question 10

What are the causes of retinal artery occlusion?

Answer 10

• embolus
• arterial wall spasm e.g. giant cell arteritis
• inflammation

Question 11

What are the symptoms of retinal artery occlusion/

Answer 11

• sudden , unilateral painless vision loss

- PMH of temporary painless loss of vision in one eye.

Question 12

What are the signs of retinal artery occlusion?

Answer 12

• pale retina

- centre of macula may stand out as a cherry red spot

Question 13

What are the differentials for retinal artery occlusion?

Answer 13

• retinal detachment
• vitreous heamorrhage
• retinal vein occlusion
• acute glaucoma

Question 14

What invx are done for retinal artery occlusion?

Answer 14

• fluorescein angiogaphy

- optical CT

Question 15

What are the treatments for retinal artery occlusion?

Answer 15

• ocular massage (to try and dislodge the obstruction)
• lower intraocular pressure
• intra arterial fibrinolysis (injection of urokinase)
• Carotid endartectomy

Question 16

What are the differences (symptoms and signs) between retinal vein vs artery occlusions?

Answer 16

1) Symptoms: SAME

Vein : unilateral painless loss/blurred vision.

Artery: unilateral painless vision loss.

2) Signs on fundoscopy:

Vein : widespread dot blot haemorrhages / flame haemorrhage

Artery: Pale retina, centre of macula stands out as a cherry red spot.