This document discusses retinal artery occlusion. Key points: - It typically affects people in their mid-60s and is more common in men. - Embolism, usually from the heart or carotid artery, is the most common cause. - Symptoms include sudden severe vision loss in one eye. On examination, the retina appears opaque and edematous with a narrowed artery. - Visual loss is usually permanent if not treated within 90 minutes. Prompt diagnosis and treatment aimed at dissolving the clot are needed to preserve vision.

3. Epidemiology
 Mean age – mid 60”s
 Men > women
 Bilateral in 1 – 2%
 May have other retinal vascular disease

4. Etiology
 Systemic hypertension seen in two thirds of patients
 Diabetes mellitus
 Cardiac valvular disease seen in one fourth of patients
 Cardiac anomalies, such as patent foramen ovale
 Embolism
Embolism is the most common cause. The
carotid artery and the heart are the most
common sources.

5.  There are 3 types of
emboli
1. Cholestrol
Hollenhorst plaques
Minute , bright , refractile,
Golden to yellow orange
crystals, often at
bifurcation

6. 2. Fibrin platelet
Dull grey , elongated
particles which are
usually multiple

7. 3. Calcific emboli
Single , white , non
scintillating particles

8. Pathophysiology
Emboli artery narrowing atheroma turbulent blood flow
break off atheroma lodge small caliber arteryt block
Ischemia Retinal artery occlusion

9. Characteristics
Sudden severe visual loss in 1 eye
Painless
Retinal appearance
 Opaque and edematous
 Retina artery narrow，mild hemorrhage
 Most prominent in posterior pole
 Thickest ganglion cell layer
 Cherry-red spot

11. With time
 Artery re-canalizes
 Edema clears
 Visual loss is
devastating and
permanent
 Irreversible damage to
neural tissue after 90
minutes

12. Diagnosis
 Ocular examintain
 Cardiovascular examination
 Labortory studies are helpful
/ blood sugar , cholesterol , triglycerid /
 Carotid ultrasound
 Fluorescein angiography
 Electroretinogram
 ECG and echocardiogram

13. Dislodge the Embolus
 “Burst the Dam”
 Digital massage to
dislodge embolus
 A/C paracentesis
 IV acetazolamide
 Retrobulbar vasodilators
 Inject fibrinolytic in
supraorbital artery
 Retrobulbar vasodilators
 YAG laser embolysis
 Surgical embolysis
Keep the Retina Alive
 Carbogen inhalation
 Oxygen inhalatioN
 Hyperbaric oxygen
therapy
 Emergent TPPV with or
without perfluorocarbon
liquid infusion

14. Ocular massage

15.  Sudden profound altitudinal
or sectoral VF loss
 VA – variable
 Fundus – narrowing of
arteries and veins with
sludging and segmentation
of the blood column / cattle
trucking , box carrying/
 One or more emboli may
seen
 Cloudy white retina that
corresponds to the area of
ischaemia.
 Sign may sometimes be
subtle.

16.  Management is directed
toward determining
systemic etiology factors.
No specific ocular therapy
has been found to be
effective in improving the
visual progmosis.pressure
on the globe may dislodge
an embolus from a large
central vessel toward a
more peripheral location ,
but the efficacy of this
maneuver in improving
visual outcomes is
unknown

17.  Atherosclerosis is
the most common
etiology
 but possible causes
include
Eisenmenger
syndrome , giant cell
arteritis , and other
inflammatory
conditions.

18.  A severe form of
chronic ischemia of
both anterior and
posterior segments
of the eye as well as
other orbital
structures supplied
by the ophthalmic
artery.
 Usually unilateral
 Age: 50-80 yrs
 M&F 2:1

19. Anterior Segment
 Dilated Episcleral
vessels
 Pain in orbit
 Corneal edema
 AC Cells
 Iris
neovascularisation
 Neovasuclar
Glaucoma

21.  Proliferative diabetic
retinopathy
 Ischemic CRVO
 Carotid artery
ultrasound
Carotid occlusion, usually
90% or more
 ERG
Diminished b- and a- waves

22.  Full scater PRP
 Carotid artery stenting
 Endarterectomy

24.  On fundus
fluorescein
angiography,
there was a
delay in
arterial filling
and AV transit
time was 70
sec

26.  fundus fluorescein
angiography showed
normal retinal
perfusion with AV
transit time of 12
seconds
 One day after IAT, his
vision improved to
20/40

27.  Fundus photography 2
weeks after
thrombolysis . There is
no more retinal edema