- Typically unilateral.
- More commonly affect older people in their mid-sixties, but can
also occur in younger patients.
- Most common cause: systemic hypertension.
- Other etiologies: diabetes mellitus, emboli from valvular heart
diseases, carotid atherosclerosis and DVT, circulatory compromise,
coagulopathies, collagen vascular diseases, other vasculitides and
trauma.
- Clinical features:
- Symptoms:
- Sudden, painless loss of vision
- May have a history of amaurosis fugax
- Signs:
- Normal anterior segment in acute cases
- Pale, whitening, swelling retina especially in the posterior
pole
- Cherry red spot as a presentation of orange reflex from
the intact choroidal vasculature beneath the foveola surrounded
by the retinal pallor
- Afferent pupil defect is usually present
- Emboli may be seen
- After 4-6 weeks, the cloudy swelling retinal commonly resolves,
leaving a pale optic disc, attenuated retinal vessels, segmentation
or "boxcarring" of the blood column
- In most cases, neovascularization of the iris usually present
by this time
- Final visual acuity is most often worse than 20/400
- Visual acuity of better than 20/40 may be achieved with
patent cilioretinal artery
- Fluorescein angiography demonstrates:
- Delay in retinal arterial filling and arteriovenous transit
time
- Segmentation of the blood column
- Choroidal vascular filling is usually normal
- Management:
- Thorough evaluation of systemic etiology.
- May consider the following treatment to lower the intraocular
pressure: ocular massage, anterior chamber paracenthesis.
- Other treatments may include: oral vasodilator and systemic
anticoagulants.
- Panretinal photocoagulation in the presence of iris neovascularization.
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