retinal vein and artery occlusion

Question 1

what will be seen on endoscopy of retinal vein occlusion?

Answer 1

Flame and blot haemorrhages
Optic disc oedema
Macula oedema

Question 2

what is the management for retinal vein occlusion?

Answer 2

Laser photocoagulation
Intravitreal steroids (e.g. a dexamethasone intravitreal implant)
Anti-VEGF therapies (e.g. ranibizumab, aflibercept or bevacizumab)

Question 3

what is the pathophysiology of how retinal vein occlusion can cause problems?

Answer 3

Blockage of a retinal vein causes pooling of blood in the retina.

This results in leakage of fluid and blood causing macular oedema and retinal haemorrhages. This results in damage to the tissue in the retina and loss of vision.

It also leads to the release of VEGF, which stimulates the development of new blood vessels (neovascularisation).

Question 4

what are the risk factors for retinal vein occlusion?

Answer 4

Hypertension
High cholesterol
Diabetes
Smoking
Glaucoma
Systemic inflammatory conditions such as systemic lupus erythematosus

Question 5

what is the most common cause of retinal artery occlusion?

Answer 5

retinal artery is atherosclerosis.

It can also be caused by giant cell arteritis, where vasculitis affecting the ophthalmic or central retinal artery causes reduced blood flow.

Question 6

why does occlusion of the retinal artery cause a relative afferent pupillary defect?

Answer 6

This is where the pupil in the affected eye constricts more when light is shone in the other eye compared when it is shone in the affected eye.

This occurs because the input is not being sensed by the ischaemic retina when testing the direct light reflex but is being sensed by the normal retina during the consensual light reflex.

Question 7

how does retinal artery occlusion present?

Answer 7

1. sudden painless loss of vision
2. relative afferent pupilary defect
3. pale retina with cherry spot on fundoscopy

Question 8

how id retinal artery occlusion treated?

Answer 8

1. high dose steroids if GCA- 60mg pred

immediate management:

• occular massage
• remove fluid from anterior chamber to reduce pressure
• inhale carbogen to dilate artery
• sublingual isosorbide dinitrate

long term
- secondary prevention of cardiovascular disease