The daily education pearl – central retinal artery occlusion

Central retinal artery occlusion

With thanks to Yusuf.

 

The central retinal artery is the first branch of the ophtalmic artery, which is the first intracranial branch of the internal carotid artery.

Causes

emboli – thrombotic, fat, amniotic fluid, air – AGE

thrombosis

vasculitis

compression in the orbit – retroorbital haematoma; thyroid exophtalmos

trauma

sickle-cell crisis

Symptoms: severe loss of vision that develops over seconds; painless

Examination: decreased VA; prominent afferent pupillary defect; fundoscopic exam: macular cherry red spot (fovea – sparred) with a pale retina and less pronounced arteries

Treatment: depends on the cause

Thromboembolic causes: aim to dislodge the clot from the main artery to one of its branches:

–  digital massage (digital pressure through closed eyelids for 10 – 15 sec then sudden release)

– vasodilation (by increasing pCO2 – rebreathing into a paper bag)

– lowering intraocular pressure – topical Bblockers; iv acetazolamide; anterior chamber paracentesis

Vasculitis: corticosteroids (1 – 2 weeks to loss of vision in the other eye if not treated)

Sickle-cell crisis: iv fluids, reverse precipitant cause

Decompression sickness: hyperbaric therapy

 

They all need urgent Ophtalmology referral.

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