Central retinal artery occlusion

Background

Etiology

1. Retinal Embolism (20%)
2. Atherosclerotic changes
3. Angiospasm
4. Inflammatory Endarteritis

Epidemiology

1. Bilateral 1-2%
2. M>F

Symptoms

Painless, monocular loss of vision

DDx

1. Amaurosis fugax (painless, fleeting; nl exam)
2. CRVO (painless, over hours; blood and thunder)
3. Temporal Arteritis
4. Acute glaucoma (blurry vision, eye pain)

Exam

1. Pale retina with edema
2. Cherry red spot at the macula
3. APD
4. Boxcar segmentation of blood column

Workup

1. Fundoscopic exam
2. CBC, ESR, EKG

Treatment

1. Ocular massage
2. Anterior chamber paracentesis
3. Intraarterial fibrinolysis
4. Acetazolamide
5. Mannitol
6. Timolol
7. Steroids
8. Hyperbarics (most effective if within 2-12h of presentation)

Dispo

Admit: comorbid disease

D/C: f/u with ophtho in 1-4 weeks

Source

H-N