Daily Bolus of LR: Central Retinal Artery Occlusion

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November 2, 2011 by dailybolusoflr

Central Retinal Artery Occlusion

 

·         Is predominantly a disease of older patients, usually over 60

·         Many patients have associated atherosclerosis as well as risk factors for this such as diabetes and HTN

·         Typical presentation is sudden, painless, unilateral, severe vision loss

o   Typical visual acuity on presentation is finger counting or light perception in 90% of patients

·         An APD is usually present

·         Classic appearance of the fundus may not be present initially but is seen shortly after the event occurs.  The retina is usually white/pale with a classic “cherry-red spot” at the fovea.  This spot is red as it retains blood flow from the choroid.

·         The etiology is often embolic (very common) or thrombotic.  Giant cell arteritis may contribute to a very small percentage of patients

·         Length of time over 90 minutes often has a very poor prognosis

·         Treatment is often unsuccessful but can involve the following:

o   Globe massage to try to dislodge the embolus further downstream- moderate pressure for 5 seconds and release for 5 seconds

o   Decrease IOP (anterior chamber paracentesis, acetazolamide IV, timolol drops)

o   Ophthalmic artery instillation of tPA

 

View the fundus here: http://www.bmii.ktu.lt:8081/unrs/eyes?trg=oneimg&nr=11&image=1

 

Ref: INTERNATIONAL OPHTHALMOLOGY CLINICS Volume 49, Number 3, 63–79

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