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

Pale retina with edema

Cherry red spot at the macula

APD

Boxcar segmentation of blood column

W/U

Fundoscopic exam

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