Topic A2

Question 1

What are some of the general symptoms of Retinal Artery/Vein Occlusions?

Answer 1

1) Loss of Peripheral Vision
2) Blind Spots
3) Floaters
4) Blurry Vision

Question 2

What are the causes of Retinal Artery Occlusions?

Answer 2

Blockages in the artery/arteries due to
1) Clot
2) Embolism - the “broken apart” parts of a clot/the matter causing the blockage
3) Build-up of cholesterol in any artery

Question 3

What is the appearance of a CRAO?

Answer 3

A cherry red spot
- reddish foveola on a pale retina
- due to choroidal blood circulation below fovea

Question 4

What are the signs & symptoms of CRAO?
*Hint - 9

Answer 4

1) Early attacks of Amaurosis Fugax
- Sudden & temporary loss of vision
2) Sudden painless loss of vision to light perception/counting fingers over seconds
3) RAPD
4) Arterial Narrowing
5) Retinal Hole/ Ischemia
6) Retina whitens with a cherry red spot within HOURS
7) VF defects
8) Optic atrophy
9) Presence of cilioretinal artery
- to help preserve macular function for central vision

Question 5

What is the management guidelines for CRAO?

Answer 5

1) Immediate referral
- rapid intervention within 90 min
2) Treatment includes
- Reducing IOP
- surgical removal of emboli
- Vasodilation = widening of BV to relax its muscular walls and increase O2 supply & dislodge emboli

Question 6

What is the etiology for BRAO?

Answer 6

1) Similar to CRAO but its visual prognosis is 6/12 or better
2) Embolus small enough to pass through laminar region & to be lodged @ an arterial branch
3) common @ superotemporal retina

Question 7

What are the signs and symptoms of BRAO?

Answer 7

1) Early attacks of Amaurosis Fugax
2) Distribution is dependent on location of affected BV
3) Arterial Narrowing
4) Retinal Hole
5) Retina whitens cause of hypoxia within hours
- this only occurs to the areas surrounding the affected arterial branch

Question 8

What is the management guidelines for BRAO?

Answer 8

1) Immediate Referral
2) Treatment similar to CRAO
-

Question 9

What is the management guidelines for BRAO?

Answer 9

1) Immediate Referral
2) Treatment similar to CRAO
- Reducing IOP
- surgical removal of emboli
- Vasodilation = widening of BV to relax its muscular walls and increase O2 supply & dislodge emboli

Question 10

What causes Venous Occlusive Diseases?

Answer 10

Blockage in the veins caused by a clot (thrombus)

Question 11

What happens in BRVO & what causes it?
(Basic/General answer is sufficient)

Answer 11

1) A thrombus occurs @ arteriovenous crossing points
2) causes compression & occlusion of retinal vein

Question 12

What happens in CRVO?
(Basic/General answer is sufficient)

Answer 12

A thrombus occludes the CENTRAL retinal vein near the lamina cribrosa?

Question 13

What are the risk factors for venous occlusive diseases?

Answer 13

1) Age - >65 y/o
2) Hypertension
3) Hyperlipidemia
4) Diabetes
5) Glaucoma & Ocular Hypertension

Question 14

What is the most common cause for BRVO?

Answer 14

Systemic Hypertension

Question 15

What are the symptoms of BRVO?

Answer 15

** Depends on the location on occlusion
1) Macula - sudden painless onset of blurred vision & metamorphopsia
2) Peripheral - Asymptomatic

Question 16

What are the signs of BRVO?

Answer 16

** Depends on the location on occlusion
1) Dilation & tortuosity of affected region
2) Flame-shaped haemorrhages
3) Dot-blot haemorrhages
4) Retinal &/or macular oedema
5) CWS
6) supertemporal quadrant is commonly affected
7) Retinal neovasc. in 8% of eyes in 3 years
8) NV @ disc (other places is possible too)
- Risk of tractional RD

Question 17

What is the symptoms of non-ischemic CRVO?

Answer 17

1) Sudden painless monocular decreasing in vision
2) VA varies based on severity
- Eyes w good VA = good prognosis
- Eyes VA worse than 6/60 = may lead to ischemia CRVO
3) RAPD - absent/mild

Question 18

What is the symptoms of non-ischemic CRVO?

Answer 18

1) Sudden painless monocular decreasing in vision
2) VA varies based on severity
- Eyes w good VA = good prognosis
- Eyes VA worse than 6/60 = may lead to ischemia CRVO
3) RAPD - absent/mild

Question 19

What are the signs of non-ischemic CRVO?

Answer 19

1) Dilated & Tortuous veins
2) Flame-shaped haemorrhages
3) Dot-blot haemorrhages
4) Optic disc & macular oedema
5) CWS - esp in px w hypertension

** more common

Question 20

What happens in ischemic CRVO?

Answer 20

There will be a rapid onset of venous obstructions that will
- reduce retinal blood flow
- capillary closure
- retinal hypoxia

Question 21

What are the symptoms of ischemic CRVO?

Answer 21

1) Sudden & severe monocular painless visual impairment
2) VA = Counting Fingers
- poor visual prognosis due to macular ischemia
3) RAPD

Question 22

What are the signs of ischemic CRVO?

Answer 22

1) “Blood & thunder” fundus
2) Severe tortuosity & engorgement of vein
3) Extensive flame-shaped haemorrhage
4) Extensive dot haemorrhages
5) Severe disc swelling & hypertension
6) Neovasc. @ iris
Aka rubeosis iridis
7) Neovasc. @ retina

Question 23

What are the 4 tests to find out the difference between non-ischemic & ischemic CRVO?

Answer 23

1) VA - eye w CRVO will have a VA worse than 6/120
2) Peripheral VF
- Non-ischemic CRVO: Sensitive to small & dim target
- Ischemic CRVO: Only able to see large & bright target
3) RAPD
- Non-ischemic CRVO: 97% of eyes had a RAPD of < 0.6 log units
- Ischemic CRVO: 94% of the eyes had a RAPD of > 0.9 log units
4) Electroretinography - To look at the amplitude of the B-wave to differentiate b/w ischemic & non-ischemic CRVO
- Best test with the best sensitivity & specificity

Question 24

What are the management guidelines for BRVO & CRVO?

Answer 24

1) Anticoagulants to prevent thrombus propagation
2) Pan retinal photocoagulation (PRP) to prevent neovasc.