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0V2022 Introduction to eye diseases > Vascular occlusions > Flashcards

Vascular occlusions Flashcards

1
Q

Where do vascular occlusions occur ?

A
  • tend to be unilateral so occur in one eye

- very rare bilateral

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2
Q

What are the symptoms of vascular occlusions ?

A
  • Unilateral sudden painless loss of vision

- May go unnoticed by elderly patient

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3
Q

Who does the vascular occlusions affect ?

A

-Typically affects the elderly

Not exclusively

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4
Q

What is central retinal artery occlusion ?

A
  • Obstruction of central retinal artery by embolus or thrombus
  • Usually below surface of optic nerve head
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5
Q

What is the epidemiology of the central retinal artery occlusion ?

A
  • Onset mid-sixties
  • Male to female ratio 2:1
  • Rare (incidence 1.9 in 100,000 in U.S.)
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6
Q

What does the px present with when have central reitnal artery occlusion?

A
  • Sudden painless profound loss of vision

- May be preceded by transient loss of vision

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7
Q

What is this transient loss of vision called ?

A

-Amaurosis Fugax

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8
Q

what is amaurosis Fugax?

A
  • transient obscuration of retinal artery by embolus
  • transient ischaemic attack (TIA)< 24 hours
  • causes a sudden monocular loss of vision
  • painless
  • ‘like blind coming down’
  • clears slowly in reverse direction
  • repetitive ( can happen 2 or 3 types in 24 hours)
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9
Q

what is the optometric management of Amaurosis Fugax?

A
  • refer to G.P. urgently after excluding giant cell arteritis
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10
Q

what are the symptoms of central retinal artery occlusion ?

A

. visual acuity usually CF ( count fingers ) to LP ( light perception )
. exceptions cilio-retinal artery (25%)

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11
Q

what are the early signs of central retinal artery occlusion?

A

1- pale oedematous retina especially at the posterior pole

2- cherry red spot at macula
. macula blood supply from choroid via posterior ciliary arteries
. surrounding retina pale in comparison
. macula is thinner - so transparency

  1. arterial attenuation - thinner artery
  2. segmentation - changes at artery
  3. emboli may be seen
  4. RAPD- do swinging light test
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12
Q

what are the late signs of central retinal artery ?

A

. optic disc atrophy

. arterial attenuation and segmentation

. VA usually remains markedly reduced despite treatment

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13
Q

what are the causes of central retinal artery occlusion ?

A
  • embolus > thrombus
  • embolus-carotid artery and heart disease

. cholesterol crystals from carotid arteries
. platelet-fibrin emboli arising from large vessel stenosis
.calcific emboli arising from carotid valve stenosis

  • thrombus
    . blood clot
    . stenosis
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14
Q

what is embolus caused by ?

A
  • cholesterol crystals from carotid arteries
  • platelet-fibrin emboli arising from large vessel stenosis
  • calcific emboli arising from carotid calve stenosis
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15
Q

what is thrombus caused by?

A
  • blood clot

- stenosis of carotid artery

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16
Q

what are the risk factors central retinal artery occlusion?

A
  • systemic hypertension
  • diabetes mellitus
  • hyperlipidemia
  • carotid artery disease
  • coronary artery disease
  • TIA/CVA
  • giant cell arteritis
  • tobacco smoking
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17
Q

what is the optometric management of central retinal artery occlusion?

A
  • measure visual acuity
  • check pupils
  • urgent referral to eye casualty (if < 12 hours old)
  • first aid - aim to dislodge embolus
    . ocular digital massage
    . breathe into paper bag ( increased CO2 levels)
  • aim is to get embolus to move through the ocular system to unblock
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18
Q

what is the ophthalmological management of central retinal artery occlusion?

A

1- reduce IOP
. anterior chamber paracentesis
. intravenous acetazolamide and ocular massage

2-dilation of arteries
. ocular massage
. retrobulbar vasodilator drugs
. inhalation of carbogen
. lysing of embolus/thrombus
. systemic anticoagulants

3- investigation of cause
. increased mortality with presence of emboli

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19
Q

how prevalent is central retinal artery occlusion: with cilio-retinal artery ?

A
  • 20% population have cilio-retinal artery
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20
Q

what is branch retinal artery occlusion ?

A
  • occur in seventh decade
  • results from embolus
  • 90% temporal retinal arteries
  • sudden painless loss of vision
    . hemifield or sector loss of vision
    . altitudinal VF loss- superior visual field defect
  • prognosis good
    . 74%-V/A 6/12 + VF defect
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21
Q

what is central retinal vein occlusion ?

A

. obstruction of central retinal vein below lamina cribosa

22
Q

what is the epidemiology of central retinal vein occlusion?

A
  • more commonly affect older people in their mid-sixties , but can also occur in younger patients
  • male to female ration equal 5.2 in 1,000
23
Q

what is the presentation of central retinal vein occlusion?

A
  • sudden painless loss of vision
  • variable deficit
  • may go unnoticed
24
Q

what are the signs of central retinal vein occlusion ?

A 
. 'blood and thunder'
. flame-shaped haemorrhages in all 4 quadrants
. disc oedema
. venous dilation 
. multiple cotton wool spots 
. RAPD likely
25
Q

what are the two types of central retinal vein occlusion ?

A
  1. Non-ischaemic

2. ischaemic

26
Q

what are the signs of non-ischaemic central retinal vein occlusion?

A 
. VA is better than 6/60
. RAPD is not marked
. less haemorrhages
. no/few cotton wool spots
. 20% become ischaemic
27
Q

what are the signs of ischaemic central retinal vein occlusion?

A 
. visual acuity <6/60 less
. Marked RAPD
. extensive haemorrhages in 4 quadrants
. disc swelling
. venous tortuosity
. cotton wool spots
28
Q

what are the central retinal vein occlusion complication ?

A
  • neovascular changes: new blood vessels in the iris or within the trabecular meshwork
29
Q

what do neovacular changes cause ?

A
  • neovascular glaucoma
30
Q

what is neovascular glaucoma ?

A 
. caused by retinal hypoxia
. angiogenesis substance released 
. new vessels develop in angle 
. fibrovascular membrane develops across trabecular meshwork 
. early intervention required
. intractable and devastating
31
Q

what are the systemic causes of central retinal vein occlusion ?

A
  • systemic hypertension
  • diabetes
  • arteriosclerosis
  • hyperviscosity syndromes
  • oral contraceptive pill
32
Q

what are the ocular causes of central retinal vein occlusion?

A
  • raised IOP>30mmHG
33
Q

what are the optometric management of central retinal vein occlusion?

A
  1. check IOP
  • Normal IOP
    . refer to ophthalmologist within 2 weeks
    . refer to GP for full cardiovascular investigation
  • if IOP>30mmHG
    . refer to ophthalmologist within 24 hours and refer to G.P for full cardiovascular investigation
34
Q

what is the ophthalmological management of central retinal vein occlusion ?

A
  1. flurorescein angiogram
    - to determine if ischaemic or non-ischaemic
  2. new vessels
    - pan-retinal photocoagulation
    - intra-vitreal anti-VEGF?
  3. macula oedema
    - intravitreal steroids
    e. g. triamcinolone acetonide
    - intravitreal anti-VEGF ( e.g. lucentis )- TO REDUCE INFLAMMATION

. investigation and treatment of underlying cause

35
Q

what is branch retinal vein occlusion?

A
  • hemi field visual loss
  • obstructed vein dilated and tortuous
  • retinal oedema
  • scattered superficial and deep retinal haemorrhages
    . respect the horizontal midline, confined to one quadrant
36
Q

what are the causes of branch retinal vein occlusion?

A

changes in systemic cardiovascular changes

37
Q

what is the optometric management of branch retinal vein occlusion ?

A
  • measure visual acuity
  • fundus examination
    . dilated BIO
  • pupil reactions
  • visual field
  • refer to GP cardiovascular investigation
  • ophthalmological referral
38
Q

what is the ophthalmological management of branch retinal vein occlusion?

A

. fluorescein angiogram
. grid laser coagulation if macula oedema persistent
. retinal neovascularisation refer in BRVO
. prognosis good if treated VA > or equal 6/12
25% will have VA < 6/60

39
Q

what is anterior ischaemic optic neuropathy ?

A

. ischaemia of anterior optic nerve head

. occlusion the posterior ciliary arteries

40
Q

what is the epidemiology of anterior ischeamic optic neuropathy ?

A
  • almost exclusively after the age of 50 years
  • incidence 18 per 100,000 after 50 years
  • women > men ( 2:1 )
41
Q

what are the two types of anterior ischaemic optic neuropathy ?

A
  • arteritic (A-AION)

- non-arteritic (NA-AION)

42
Q

what is arteritic ( A-AION)

A
  • 5-10% cases
  • older age group ( mean 70 years )
  • associated with temporal arteritis
43
Q

what is non-arteritic ( NA-AION)

A
  • 90-95% cases

- younger age group ( mean 60 yrs)

44
Q

what happens in A-AION?

A
  • profound loss of vision
  • pale oedematous optic nerve head
  • splinter haemorrhages
  • RAPD
  • risk of visual loss in other eye, myocardial infarction, renal failure, aortic aneurysm
45
Q

what is temporal arteritis ?

A
  • giant cell arteritis

- inflammation of medium and large arteries

46
Q

what are the symptoms of temporal arteritis ?

A 
- headache
. normally constant
. gradual onset to a diffuse severe aching
. superficial scalp tenderness- temporal
. worse at night and in the cold

. general malaise, weight loss, jaw claudication , amaurosis fugax

. polymyalgia rheumatica

47
Q

what are the presentation of NA-AION?

A
  • sudden loss of vision
    . mild to severe
    . usually on waking
    . vision loss either static or progressive
  • 20% lose vision in other eye within 5 years
  • at risk disc
  • associated with hypertension diabetes
48
Q

what are the signs of NA-AION ?

A
  • oedematous optic nerve head
    . diffuse or segmental
    . hyperaemic or pale
  • visual field loss
    . usually altitudinal
  • contralateral eye
    . small disc
    . small or absent cup
    . subsequent optic atrophy

-33% left with near normal V/A

49
Q

what is the optometric investigation of AION?

A

. VA, pupils, colour vision, VFs, IOP

. dilated fundus examination

50
Q

what is the optometric management of AION?

A

. emergency referral to casualty

. contact ophthalmologist

51
Q

what is the ophthalmological investigation of AION?

A
  • blood tests
  • temporal artery biopsy
  • scan ( Doppler, MRI)
52
Q

what is the optometric management of AION?

A
  • aspirin, treatment of cardiovascular problem

- if arteritic high doses of systemic steroids for years

0V2022 Introduction to eye diseases (22 decks)

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