Morning Report: 4/12/2012

Thanks to Dr. Guy for today’s Morning Report (presented on 4/9/2012)!

Central Retinal Artery Occlusion

Epidemiology: 

1. 55% mortality rate over 9 years
2. 2% bilateral involvement
3. mean age 62

Pathophysiology:

1.  emboli in retinal artery/ branches
2. ophthalmic artery from intraorbital branch of internal carotid artery
3. ischemia and edema
4. irreversible cell injury occurs after 90-100 minutes

Presentation:

1. acute painless vision loss
2. non-progressive vision loss
3. branch retinal artery occlusion:
• Amaurosis fugax- transient visual acuity loss preceding persistent loss of vision
• peripheral vision field loss

 Risk factors:

• Systemic hypertension seen in 2/3 of patients
• atherosclerosis
• myopia
• DM
• CAD
• atrial fibrillation
• valvular disease ¼
• cardiac abnormalities
• ss disease
• ocd
• vasculitis
• embolism
• cholesterol, calcific, bacteria, endocarditis, coaguloopathies, antiphospholilipid syndromes

Exam:

• boxcar appearance of the blood column can be seen in both arteries and vein
• afferent pupillary defect
• cherry red spot and ground glass retina- 1 hour after development
• pale optic disk seen days to weeks after event
• emboli seen 20%

Management:

• Emergency- call ophthalmology
• Controversy exists regarding the optimal window of treatment in humans
• Conservative approach involves treatment up to 24 hours
• Directed towards lowering IOP and increasing perfusion
• Only 25% regain baseline vision
• Give O2, peripheral thrombolytics, ocular massage, aspirin, hyperbarics
• Long term risk modifications

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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital

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