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Retinal Artery Embolism

Embolic Spots in Retinal Arteries


Presentation

  • Case presentation A 23-year-old woman presented with sudden painless visual loss in the left eye of 100 min. She had been diagnosed with PTA at the age of 1 month.[bmcophthalmol.biomedcentral.com]
  • Patients generally present with pain, proptosis, tense eyelids, periorbital edema, subconjunctival hemorrhage, and external ophthalmoplegia.[journals.lww.com]
  • BCVA in the present case remained at 20/25, with a permanent visual field defect in the OD.[dovepress.com]
  • His blood pressure was 230/110 mm Hg at presentation. Glycosylated haemoglobin (HbA1c) was 8.8%.[austinpublishinggroup.com]
Ecchymosis
  • Physical examination revealed clear consciousness, stable vital signs, mild redness with ecchymosis over the nasal and glabellar region, and right eye ptosis, with no light reflex of the right eye.[academic.oup.com]
  • There was no peri-orbital swelling, edema, ecchymosis, proptosis, or any other sign of venous fullness. Ocular examination revealed no perception of light in the right eye and 20/20 in the left eye.[surgicalneurologyint.com]
Anemia
  • […] posterior ischemic optic neuropathy (PION), CRAO, and cortical blindness. [ 1 ] Risk factors noted in the patients included hypertension, smoking, diabetes, vascular disease especially atherosclerosis, sickle cell disease, polycythemia and embolism, anemia[surgicalneurologyint.com]
Mitral Valve Prolapse
  • Transesophageal echocardiography for detecting mitral valve prolapse with retinal artery occlusion. Am J Ophthalmol 1991; 111: 103–4. Google Scholar 39. Wiznia RA, Pearson WN.[link.springer.com]
  • Bilateral retinal artery occlusion due to mitral valve prolapse. Br J Ophthalmol 1991;75:436-7. [ PUBMED ] [Figure 1][mjdrdypu.org]
  • […] in a series of 11 young patients with CRAO and BRAO included mitral valve thickening, left ventricular hypertrophy, thrombus with bicuspic aortic valve and mitral valve prolapse. 29 Of these, three (60%) required intervention in the form of anticoagulant[emj.bmj.com]
  • The mitral valve lesions comprised 57% calcified valve, 17% mitral valve prolapse, and 26% other types of lesions. The aortic valve lesions were 78% calcified valve and 22% other types.[dovepress.com]
Blurred Vision
  • The procedure was complicated by chest pain and the acute onset of blurred vision. Funduscopic examination revealed a white plaque in the left eye, occluding the inferior hemiretinal artery. This was interpreted as a fibrin embolus.[nejm.org]
  • If the veins cover a large area, new abnormal vessels may grow on the retinal surface, which can bleed into the eye and cause blurred vision. There is no cure for BRVO. Finding out what caused the blockage is the first step in treatment.[sneretina.com]
  • Blood clots, inflammation, infections, and the use of certain drugs are some of the known causes for Retinal Artery Occlusion The signs and symptoms of the condition include sudden blurred vision and blood clot in the eye.[dovemed.com]
Retinal Pallor
  • Retinal pallor corresponds to the area supplied by the affected artery. Occasionally, an embolus (cholesterol, fibrinoplatelet, calcific) can be seen within the artery, and cotton wool spots may eventually occur around that area.[patient.info]
  • Fundus showed reabsorption of retinal edema and resolution of retinal pallor in both eyes.[mjdrdypu.org]
  • pallor, allowing it to stand out. 1-11 Following the acute injury, the retinal appearance resolves over the course of weeks.[reviewdiseasehandbook.com]
Unilateral Blindness
  • Rene et al ( 3 ) reported a case of unilateral blindness following ESS in which direct optic nerve damage occurred in combination with central retinal arterial occlusion (CRAO).[journals.lww.com]
  • […] so conclusion: it is amaurosis ugax when the patint tells you that he has had transient episodes of blindness... it is retinal artery oclusion when the patient tells you that he or she is unilaterally blind (normally), and hasn t recovered. both are 70%[prep4usmle.com]
Transient Blindness
  • blindness, he or she is complaining of sudden visual loss right now!!![prep4usmle.com]
Periorbital Edema
  • Patients generally present with pain, proptosis, tense eyelids, periorbital edema, subconjunctival hemorrhage, and external ophthalmoplegia.[journals.lww.com]

Workup

  • Systemic workup should include an evaluation for those abnormalities associated with acute CRAO. From there your doctor will recommend a course of ocular therapy.[williamsoneyeinstitute.com]
  • In young patients a vasculitis and/or hypercoagulable workup should be performed. In older patients, an embolic workup should be performed.[eyewiki.aao.org]
  • To evaluate etiology, workup may include: -Neurology evaluation for workup and modification of risk factors. -ESR/CRP and giant cell arteritis review of systems.[webeye.ophth.uiowa.edu]
  • Diagnostic workup in CRAO and BRAO focuses on identifying the underlying etiology, in order to institute appropriate secondary prevention measures to reduce the risk of future vascular events.[dovepress.com]

Treatment

  • Unfortunately, there is no mention of the treatment given. Even in the concluding remarks, in which the authors stress the need for immediate therapy in retinal-artery occlusion, the. . .[nejm.org]
  • Bartelnik AKM, Kappelhof JP (1994) Treatment of retinal artery embolism, N Engl J Med 331: 1592–1593 CrossRef Google Scholar 2.[link.springer.com]
  • In comparison, visual improvement after conservative treatment according to three different stages is shown in Table 9. Obviously, the results after treatment with LIF are better than with conservative treatment.[ajnr.org]
  • […] was reported with treatment given after 48 hours of ischemia. 5 Nevertheless, shorter latency to treatment results in better outcomes. 38 It is therefore important to review all treatment options that aim to restore circulation to the ischemic retina[thejns.org]
  • Oxygen Therapy. [4] This a treatment for CRAO that is covered by medical insurance in North America.[en.wikipedia.org]

Prognosis

  • The prognosis is especially poor in the case of ischemic CRVO. References: [6] [7][amboss.com]
  • Prognosis Recovery of useful vision is related directly to the rapidity of treatment and presenting visual acuity.[emedicine.medscape.com]
  • CRAO is a medical emergency which has a poor prognosis if not attended to promptly. Patients particularly at risk include those with giant cell arteritis, atherosclerosis and thromboembolic disease.[wesleyhyperbaric.com.au]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • With regard to etiology, 62 patients (41.1%) had LAA, the most common etiological factor. About 40% of our patients had a RAO of undetermined etiology.[journals.plos.org]
  • Etiology: Although there are many etiologies for CRAO, carotid artery stenosis is thought to be the most common cause and is present in up to 70% of cases. 2 Cardioembolic disease is another prevalent etiology and is more likely in those under 40 and[emdocs.net]
  • Conclusions: Surgical embolectomy following pars plana vitrectomy is the only etiologic treatment for acute hemi-central retinal artery occlusion caused by calcific emboli.[evrs.eu]
  • Some patients may report that they had been experiencing episodes of transient visual loss before the current episode. 3-5 While the etiology of retinal artery obstruction is primarily embolic, plaques are not always visible. 2 As artery occlusions develop[reviewdiseasehandbook.com]

Epidemiology

  • References: [1] [2] [3] [4] [5] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Two thirds of patients experience 20/400 vision while only one in six will experience 20/40 vision or better. [1] Epidemiology [ edit ] Risk factors for CRAO include the following: being between 60 and 65 years of age, being over the age of 40, male gender[en.wikipedia.org]
  • Retinal arteriolar emboli: epidemiology and risk of stroke. Current opinions in ophthalmology, 2002, 13(3):142–6. Klein R et al. Retinal emboli and cardiovascular disease: the Beaver Dam Eye Study. Archives of ophthalmology, 2003, 121(10):1446–51.[emro.who.int]
  • 1,2 Categorized as branch (BRAO), central (CRAO), cilioretinal or ophthalmic, depending on the location of the blockage, they are not the result of a single disease but develop from several systemic abnormalities. 2,3 As such, there is no definitive epidemiology[reviewdiseasehandbook.com]
  • Diagnosis: Central Retinal Artery Occlusion (CRAO) EPIDEMIOLOGY Age 40 years old.[webeye.ophth.uiowa.edu]
Sex distribution
Age distribution

Pathophysiology

  • CRAO is the same pathophysiology in the retinal circulation.[hbot.com]
  • The pathophysiology of the disease is still not welldefined. In this case report, we are trying to illustrate a case of CRVO followed by CRAO with sequential fundus photo, and to describe the pathophysiology based on the anatomical basic.[omicsonline.org]
  • Date of Submission 12-Jan-2015 Date of Acceptance 25-Mar-2015 Date of Web Publication 25-May-2015 Dear Editor, The occurrence of postoperative visual loss (POVL) after spine surgery in prone position, although rare, has been described.[ 1 6 7 ] Various pathophysiologic[surgicalneurologyint.com]
  • Pathophysiology Blood supply to the retina originates from the ophthalmic artery, the first intracranial branch of the internal carotid artery that supplies the eye via the central retinal and the ciliary arteries.[emedicine.medscape.com]

Prevention

  • Stroke Prevention in Atrial Fibrillation Study Group Investigators. Preliminary report of the stroke prevention in atrial fibrillation study. N Engl J Med 1990; 322: 863–868. Google Scholar 24.[link.springer.com]
  • Complications of endoscopic sinus surgery: analysis of 2108 patients–incidence and prevention. Laryngoscope. 1994;104:1080–1083. 2. Bhatti MT. Neuro-ophthalmic complications of endoscopic sinus surgery. Curr Opin Ophthalmol. 2007;18:450–458. 3.[journals.lww.com]
  • Can it be prevent? In general, they cannot be prevented, which is why they are known as cardiovascular accidents.[icrcat.com]
  • Prevention Since many cases of retinal vessel occlusion are related to high blood pressure, atherosclerosis or diabetes, it may be possible to prevent this eye problem by not smoking and controlling your blood pressure, cholesterol level and blood sugar[drugs.com]
  • Measures used to prevent other blood vessel (vascular) diseases, such as coronary artery disease, may decrease the risk for retinal artery occlusion.[medlineplus.gov]

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