What is the major artery supplying the eye?
Which artery in the neck does it stem from?
Internal carotid artery
What are the important branches of the ophthalmic artery which you should know?
Central retinal artery (inner 2/3rds of retina)
Posterior ciliary arteries (optic nerve head)
Which structure supplies the other 1/3rd of the retina?
What vascular problems cause sudden visual loss?
Which artery supplies the inner 2/3rds of the retina?
Central retinal artery
What are the symptoms of central retinal artery occlusion?
Sudden profound vision loss
Which is painless
What reflex is disrupted in CRAO?
Pupillary light reflex
pupil doesn't constrict in response to light - relative afferent pupil defect (go back and forth fast enough and the pupil will actually dilate in response to light)
because optic nerve is infarcted
What does the retina look like in a central retinal artery occlusion?
Cherry spot fovea
Arteries either absent or blocked
Central retinal artery occusion is a type of ___.
What causes central retinal artery occlusion?
Carotid artery disease
How are central retinal artery occlusions managed?
Ocular massage (attempt to convert to branch occlusion)
Manage risk factors
What is amaurosis fugax?
Transient central artery occlusion
What are the symptoms of amaurosis fugax?
Transient painless visual loss
lasting 5 mins with full recovery
How is amaurosis fugax treated?
Urgent referral to stroke clinic
What is Virchow's triad?
Stasis / turbulent blood flow
What are the symptoms of central retinal vein occlusion?
Sudden painless visual loss
CRVO is associated with a raised ___ pressure.
What are the signs of CRVO on fundoscopy?
Haemorrhages - inc. cotton wool spots
Dilated torturous veins
Optic disc and macular swelling
What type of scan is used to pick up macular oedema?
How is CRVO treated?
Anti-VEGF injections (VEGF released in response to ischaemia, encourages development of poorly structured blood vessels which haemorrhage)
Address risk factors
What processes drive
occlusions of the eye?
a) Internal carotid disease
b) Venous stasis
Which arteries supply the optic nerve head?
Posterior ciliary arteries
What is occlusion of the posterior ciliary arteries also known as?
Ischaemic optic neuropathy
What tends to cause arterial ischaemic optic neuropathy?
Giant cell arteritis
What causes non-arteritic ischaemic optic neuropathy?
What does the optic disc look like in ischaemic optic neuropathy?
What is the main symptom of arteritic ischaemic optic neuropathy?
Sudden irreversible visual loss
Irreversible blindness is an end-stage symptom of giant cell arteritis. What are the other symptoms?
Tender, enlarged temporal arteries
Transient arterial occlusions (amaurosis fugax)
Raised inflammatory markers
How is giant cell arteritis treated to prevent immediate bilateral blindness?
High dose oral prednisolone
Where in the eye does bleeding tend to occur?