Retinal Artery Occlusion


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Retinal Artery Occlusion

 

Definition

Retinal artery occlusion refers to the closure of the central retinal artery and usually results in complete loss of vision in one eye. Occlusion of its branches causes loss of vision in only a portion of the field of vision.

Description

Retinal artery occlusion (RAO) occurs when the central retinal artery, the main source of blood supply to the retina, or one of its branches becomes blocked.

Causes and symptoms

The main causes of RAO are the following:
  • embolism (the sudden obstruction of a blood vessel by a blood clot)
  • atherosclerotic disease that results in the progressive narrowing of the arteries over time
  • endarteritis (the chronic inflammation of the inner layer of arteries)
  • angiospasm (a spasmodic contraction of a blood vessel with increase in blood pressure)
The most common symptom of RAO is an acute, painless loss of vision in one eye. The degree of loss depends on the location of the occlusion. If the occlusion occurs in the central artery of the retina, damage usually results in complete loss of vision in the affected eye. If occlusion occurs in a branch artery, vision loss will be partial and may even go unnoticed if only a section of the peripheral vision is affected.
People affected by RAO typically have high blood pressure, heart disease, or diabetes as an underlying condition. Other conditions that may increase the risk of RAO include high cholesterol and glaucoma. Incidence is slightly more common in men and in people age 60 or older.

Diagnosis

RAO is diagnosed by examination of the retina with an ophtalmoscope.

Treatment

Central retinal artery occlusion (CRAO) is an emergency. If treatment begins within an hour, the patient has the highest possibility of regaining vision in the affected eye, although complete restoration is unlikely.
A common treatment is inhalation of carbon dioxide so as to dilate the retinal vessels and move the occlusion from the central retinal artery to a branch artery. This movement reduces the area of the retina affected and may restore a certain amount of vision. Eyeball massage may also be performed, also in an effort to remove the occlusion. The physician may also consider puncturing the eyeball.
Drug therapy includes the use of carbonic anhydrase inhibitors to reduce the internal eye pressure and enhance movement of the occlusion. Both of the treatments would be used within the first 24 hours of noticeable vision loss.

Alternative treatment

Hyperbaric oxygen therapy may be beneficial if started within 90 minutes of the onset of symptoms. Some studies indicate a 40% improvement of visual acuity using this method.

Prognosis

The prognosis for central retinal visual acuity is poor with only about one-third of patients recovering useful vision. The longest delay in getting treatment that has been associated with significant visual recovery was approximately 72 hours.
Branch retinal artery occlusions (BRAO) have a recovery rate of 80% where vision is restored to 20/40 or better.

Prevention

Individuals affected by underlying conditions such as high blood pressure, heart disease, diabetes, glaucoma, and elevated cholesterol should treat their conditions appropriately to minimize the possibility of a retinal artery occlusion.

Resources

Organizations

American Academy of Ophthalmology. P.O. Box 7424, San Francisco, CA 94120-7424. (415) 561-8500. Fax: (415) 561-8533. http://www.eyenet.org/.
American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) DIABETES. http://www.diabetes.org/.
American Heart Association National Center. 7272 Greenville Avenue, Dallas, Texas 75231. (877) 242-4277. http://www.americanheart.org/.
CliniWeb International. 〈http://www.ohsu.edu/cliniweb/C11/C11.768.html〉.

Key terms

Angiospasm — Spasmodic contraction of a blood vessel with increase in blood pressure.
Arterioles — Small blood vessels that carry arterial (oxygenated) blood.
Atherosclerotic disease — The progressive narrowing and hardening of the arteries over time.
Central retinal artery — A branch of the ophthalmic artery that supplies blood to the retina and branches to form the arterioles of the retina.
Embolism — The sudden obstruction of a blood vessel by a blood clot.
Endarteritis — Chronic inflammation of the inner layer of arteries.
Hyperbaric oxygenation — Administration of oxygen in a compression chamber at an ambient pressure greater than 1 atmosphere, in order to increase the amount of oxygen in organs and tissues.
Occlusion — Momentary complete closure of some area or channel of the body.
Ophthalmic artery — The artery supplying the eye and adjacent structures with blood.
Ophthalmoscope — An instrument used for viewing the inside of the eye that consists of a concave mirror with a hole in the middle through which the physician examines the eye, and a light source that is reflected into the eye by the mirror.
Retina — Light sensitive layer of the eye, that consists of four major layers: the outer neural layer, containing nerve cells and blood vessels, the photoreceptor layer, a single layer that contains the light sensing rods and cones, the pigmented retinal epithelium (PRE) and the choroid, consisting of connective tissue and capillaries.
References in periodicals archive ?
3) Isolated central retinal artery occlusion is a rare, yet very devastating, complication of mitral stenosis.
Cardiologic consultation was asked for the patient diagnosed with left central retinal artery occlusion during her ophthalmologic investigation to search for the source of emboli.
For example, corticosteroids may be prescribed when the central retinal artery occlusion is due to inflammation of the temporal artery.
Occasionally they might present with hyphema, central or branch retinal artery occlusions, or ischaemic optic neuropathy, in which case they require immediate referral to an ophthalmologist for treatment.
The topic of the final case report is Susac syndrome, a fairly rare disorder characterized by the triad of encephalopathy, sensorineural hearing loss, and branch retinal artery occlusion.
These include ophthalmoplegia, uveitis, glaucoma, central retinal artery occlusion, macular infraction, optic neuritis, vitreous hemorrhage, penetrating eye injury, globe necrosis cortical infarction and endogenous endophthalmitis.
Some common causes of this serious secondary glaucoma are occlusive retinal vascular diseases such as central retinal vein occlusion (CRVO), proliferative diabetic retinopathy (PDR), central retinal artery occlusion (CRAO), inflammatory disease and intraocular tumours1.
The patient had perception of light in her right eye and 20/25 (presenting visual acuity) in the fellow eye, accompanied by right-side proptosis, total ophthalmoplegia, optic disc pallor and central retinal artery occlusion.
These findings included neuroretinitis in 4 eyes (associated with inferior peripheral serous retinal detachment in 1 eye), optic neuropathy in 2 eyes (1 with papillitis and optic disc infiltration, 1 with optic neuritis), retinal infiltrate in 6 eyes, retinochoroiditis in 1 eye, branch retinal artery occlusion in 3 eyes, and endophthalmitis in 1 eye (Table 1).
b) This technique is useful in the diagnosis of retinal artery occlusion
Hyperhomocysteinemia is reported as an independent risk factor for systemic and ocular vasoocclusive disorders, including nonarteritic ischemic optic neuropathy (NAION), central retinal artery occlusion (CRAO), and central retinal vein occlusion (CRVO), especially in young patients (4, 5).
Keywords: Optical coherence tomography, retina, retinal artery occlusion, Susac syndrome, diagnosis