retinal artery occlusion
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Etiology
- thromboembolism from the heart, carotid artery or temporal artery
- Susac syndrome
- risk factors:
Epidemiology
- 50-70 years of age
Pathology
- embolism or thrombosis in the ophthalmic artery
Clinical manifestations
- sudden transient or permanent monocular visual impairment
- painless
- often occurs in early morning
- clear cornea
- red eye
- pupil may be dilated & poorly reactive to light
- afferent pupillary defect
- may react to light in contralateral eye
Laboratory
- blood cultures if endocarditis suspected
Diagnostic procedures
- funduscopy:
- pale fundus
- attenuation of post-occulsion retinal arteries
- infarcted retina is pale & masks the underlying choroidal circulation except at the macula, where the thinness of the tissue allows it to be seen resulting in the so-called 'cherry-red spot'
- 'box-car' effect may be seen in venous drainage[1]
- emboli visible in 60%[2]
- echocardiogram vs transesophageal echocardiogram
* image (funduscopy)[5]
Complications
- permanent visual loss may occur within 100 minutes of onset
- associated with 24% risk of ischemic stroke[3]
- 5% risk of ischemic stroke within 30 day window of central retinal artery occlusion[4]
Differential diagnosis
Management
- place patient in supine position
- reduce intraocular pressure with ocular digital massage
- intravenous mannitol
- oral acetazolamide
- oral nitrates
- referral to an ophthalmologist
- prognosis
- better vision at presentation predicts better prognosis[2]
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2018.
- ↑ 2.0 2.1 2.2 2.3 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - ↑ 3.0 3.1 Helenius J et al. Concurrent acute brain infarcts in patients with monocular visual loss. Ann Neurol 2012 Aug; 72:286 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22926859
- ↑ 4.0 4.1 Chodnicki KD, Pulido JS, Hodge DO, Klaas JP, Chen JJ. Stroke risk before and after central retinal artery occlusion in a US cohort. Mayo Clin Proc 2019 Feb; 94:236 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30711121 https://www.mayoclinicproceedings.org/article/S0025-6196(18)30853-X/fulltext
- ↑ 5.0 5.1 Tamez H, Patel SN Retinal Artery Occlusion After a Dog Bite in a 55-Year-Old Man. JAMA Ophthalmol. Published online May 6, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33956084 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2779737
AMA Ed Hub. JN Learning https://edhub.ama-assn.org/jn-learning/module/2779737