3: Central Retinal Artery and Vein Occlusion

Question 1

Define central retinal artery occlusion

Answer 1

Occlusion of the central retinal artery

Question 2

Describe anatomy of central retinal artery

Answer 2

First branch of the ophthalmic artery

Question 3

What is more common central retinal artery or vein occlusion

Answer 3

Central retinal vein occlusion

Question 4

What are the 3 causes of central retinal artery occlusion

Answer 4

• Embolic
• Thrombotic from carotid.a
• Vasculitis

Question 5

What are 2 causes of embolic central retinal artery occlusion

Answer 5

AF

Thrombosis from carotid.a atherosclerosis

Question 6

What are risk factors for central retinal artery occlusion

Answer 6

Male
Age

Cardiovascular risk - CVD, Obesity, Diabetes, Smoking, HTN.

Question 7

How does central retinal artery occlusion present

Answer 7

Sudden-onset decrease in visual acuity to less than 90%

Question 8

What will be seen in central retinal artery occlusion

Answer 8

Relevant afferent pupillary defect

Question 9

What is a transient central retinal artery occlusion also known as

Answer 9

Amaurosis fugax

Question 10

Define amaurosis fugax

Answer 10

Sudden painless vision loss lasting seconds-minutes followed by spontaneous recovery

Question 11

If a carotid bruit is present in central retinal artery occlusion what does it mean

Answer 11

Carotid artery stenosis

Question 12

If irregular pulse is present in central retinal artery occlusion what may it indicate

Answer 12

AF

Question 13

If scalp tenderness is present in central retinal artery occlusion what may it indicate

Answer 13

GCA

Question 14

How often should someone be seen if they have sudden visual loss

Answer 14

within 6h

Question 15

What is an approach to sudden visual loss

Answer 15

HEELP

Question 16

What does HEELP refer to

Answer 16

H = headache

E = eye movements painful

E = ESR raised

L = lights or flashes preceding

P = poorly controlled diabetes - vitreous haemorrhage

Question 17

What does raised ESR indicate

Answer 17

GCA

Question 18

What does painful eye movements indicate

Answer 18

Optic neuritis

Question 19

What does lights or flashing indicate

Answer 19

Retinal detachment

Question 20

What may poorly controlled diabetes indicate

Answer 20

Vitreous haemorrhage

Question 21

What is seen on ophthalmoscopy in central retinal artery occlusion

Answer 21

Pale retina with cherry red spot

Question 22

explain cherry-red spot at the fovea centralists

Answer 22

There are no nerve fibres at avascular zone - therefore it is not affected by oedema of the vascular layer and can be seen as red against whit background

Question 23

what is the aim of treatment in central retinal artery occlusion

Answer 23

increase blood flow

Question 24

what are methods to increase intra-ocular blood flow

Answer 24

ocular massage
surgical removal aqueous
intra-ocular HTN Rx

Question 25

what is the problem with central retinal artery occlusion

Answer 25

- Causes retinal ischaemia - This stimulates VEGF secretion - Neovascularisation increases risk of vitreous haemorrhage and subsequent retinal detachment

Question 26

What is central retinal vein occlusion

Answer 26

occlusion of central retinal vein

Question 27

In which age group does central retinal vein occlusion occur

Answer 27

>60

Question 28

What are 5 causes of central retinal vein occlusion

Answer 28

``` Atherosclerosis HTN Hypercoagulable state Diabetes Glaucoma ```

Question 29

What are 3 hyper coagulable stages

Answer 29

COCP Polycythaemia Sickle cell

Question 30

How does central retinal vein occlusion present clinically

Answer 30

Sudden painless visual loss

Question 31

How does central retinal vein occlusion present on fundoscopy

Answer 31

flame-shaped haemorrhages in all 4-quadrants giving a stormy sky appearance

Question 32

How quickly should central vein occlusion be referred

Answer 32

same-day ophthalmology referral

Question 33

if visual loss has occurred, what is used to manage central retinal vein occlusion

Answer 33

1. anti-VEGF 2. Dexamethasone 3. Photocoagulation

Question 34

what is complication of central retinal vein occlusion

Answer 34

ischaemia leads to neovascularisation = increases risk of vitreous haemorrhage