Vascular Problems

Question 1

What blood vessels supply the optic nerve head?

Answer 1

Posterior ciliary arteries

Question 2

What causes arteritic ischaemic optic neuropathy?

Answer 2

Giant cell arteritis

Inflammation of the walls of the vessels supplying the optic nerve. This narrows their lumen resulting in ischaemia

Question 3

How does giant cell arteritis present?

Answer 3

Headache
Scalp tenderness
Prominent/tender temporal artery
Painless visual disturbances
Jaw claudication

Question 4

How is giant cell arteritis managed?

Answer 4

Temporal artery biopsy and urgent high dose steroids

Question 5

What causes non-arteritic ischaemic optic neuropathy?

Answer 5

Atherosclerosis of posterior ciliary arteries

Question 6

What is central retinal artery occlusion?

Answer 6

Occlusion of the only artery supplying the inner 2/3rds of the retina which can result in blindness (form of stroke)

Question 7

How does central retinal artery occlusion present?

Answer 7

Sudden painless sight loss

Relative afferent pupil defect

Question 8

What can be seen on fundoscopy with central retinal artery occlusion?

Answer 8

Pale oedematous retina

Cherry red macula (it has different blood supply)

Question 9

What management options are there for central retinal artery occlusion which presents within 24 hours?

Answer 9

Treatments to try and move embolus to less critical artery

Ocular massage

Withdraw fluid from anterior chamber

Patient hold breath (increases CO2 which vasodilates)

Question 10

What is amaurosis fugax?

Answer 10

Transient vision loss caused by transient central retinal artery occlusion

Question 11

What do you do with a patient who has had an episode of amaurosis fugax?

Answer 11

Ask about symptoms of giant cell arteritis

Give aspirin

Urgent stroke clinic referral

Question 12

What is a branch retinal artery occlusion?

Answer 12

Occlusion of an artery which supplies part of the retina which causes patients to lose part of their visual field

Question 13

What is a central retinal vein occlusion?

Answer 13

Occlusion of central retinal vein which causes a back pressure of blood in the retinal veins which eventually burst around the fundus

Question 14

How does central retinal vein occlusion present?

Answer 14

Sudden painless moderate-severe vision loss

Question 15

What can be seen on fundoscopy with central retinal vein occlusion?

Answer 15

Dramatic appearance

Widespread oedema and haemorrhage

Dark retina

Disc swelling (loss of contour)

Dilated tortuous veins

Question 16

What is the management of central retinal vein occlusion?

Answer 16

Problems largely caused by ischaemia

• Laser treatment
• Anti-VEGF injections

Address risk factors (diabetes, hypertension)