Retinal vessel occlusions

Question 1

Describe the appearance of the retina in a retinal vein branch occlusion

Answer 1

Segment of a pizza

Question 2

Describe the appearance of the retina in a central retinal vein occlusion

Answer 2

Whole pizza - haemorrhages, soft exudates, blurred optic disc margin, neovascularisation, cystoid macular oedema, dilated tortuous veins

Question 3

Describe the appearance of the retina in a central artery occlusion

Answer 3

Pale retina
Cherry red spot (macula receives dual blood supply - choroid)
Arterial narrowing and silver wiring
Neovascularisation - chronic ischaemia

Question 4

Give the key symptom of a vessel occlusion and describe the difference in the symptom between central and branch occlusion

Answer 4

Painless loss of vision - segmental if branch vein occlusion

Question 5

What are some risk factors of retinal vessel occlusion?

Answer 5

HTN, smoking, DM, glaucoma, obesity, hyperlipidaemia, malignancy, COCP, FH of thrombophilia, previous DVT, recurrent miscarriage, active/previous malignancy

Question 6

What investigations should be carried out in someone presenting with central retinal artery occlusion

Answer 6

CV exam 
VA
Colour vision 
Pupil exam (RAPD)
BP
ECG
Full cardiac workup - FBC, ESR, CRP, Coagulation screen, glucose and lipid profile, US doppler carotid and echo

Question 7

What is the management of central retinal artery occlusion?

Answer 7

Exclude GCA
High dose aspirin within 90 mins - 300mg for 14 days
Secondary prevention - anticoagulant
Dislodge embolus - rebreathing in a bag, ocular massage, reduce IOP with IV acetazolamide

Question 8

How long should a patient not drive for after a central retinal artery occlusion?

Answer 8

1 month

1 year for commercial drivers and they must inform the DVLA

Question 9

What are some complications of central retinal artery occlusion?

Answer 9

Neovascularisation of optic disc, fundus or iris (neovascular glaucoma - new vessels occlude the drainage angle and result in increased pressure)

Question 10

Which artery supplies the retina?

Answer 10

Retinal artery

Question 11

What is the cause of vessel occlusion in someone over 50yo?

Answer 11

Atherosclerotic process

Question 12

What is the cause of vessel occlusion in someone under the age of 50yo?

Answer 12

Hypercoagulable state - think Virchow’s triad - COCP, cocaine, malignancy, pregnancy