10b. Retinal Arterial Occlusions

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Author:
sookylala
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235325
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10b. Retinal Arterial Occlusions
Updated:
2013-11-09 04:31:49
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  1. Most common causes for RAO?
    • atherosclerosis at lamina cribosa/crao-80%
    • carotid embolism- from carotid bifurcation
    • GCA
  2. Who does RAO usually affect?
    • 10-90 usually 60
    • m
  3. Things to look for in RAO?
    • cherry red spot
    • abrupt painless loss of VA
    • ischaemia
    • NVI
    • GCA
    • amarousis fugax
    • embolus
  4. FA with RAO?
    • delayed arterial filling
    • masking of bg choroidal hyper
  5. prognosis with RAO?
    • poor due to retinal infarction
    • ~few weeks cherry red spot/clodiness disappear
    • atrophi inner retinal layers
    • optic atrophy
    • permanenet loss of VA
    • NVI
    • arteries attenuated
  6. Types of emboli in RAO?
    • cholesterol: showers of golden crystals
    • calcific: from atheromatous plaqus from aorta/carotid, sngle white
    • fibrin platelet: dull grey, elongated particles-> TIA
  7. if spotted RAO?
    • emergency!
    • irreversible visual loss unless retinal circulation can be restored
  8. CRAO presentation?
    • sudden painless profound loss of VA
    • RAPD
  9. Fundus presentation of CRAO?
    • cherry red spot
    • if cilioret art- macular=normal
    • retinal edema
    • diffuse ischaemia
    • box carring blood
  10. Cilioretinal artery obstruction types?
    • 1. isolated: younger with collagen vascular disorder- good prog
    • 2. CilRVO+CRVO: similar to nonischaemic CRVO with good central visual prognosis
    • 3. CiRVO+ischemic optic neuropathy: poor prognosis
  11. BRAO info?
    • rare
    • RE>LE-> right cartoid artery
    • affects temp retinal circ>nasal: blood flow to macula in temp retina
  12. Presentation of BRAO?
    • abrupt VA loss in field of occluded artery
    • VA variable with intact central VA
    • RAPD
  13. Fundus presentation of BRAO?
    • retinal cloudiness whitening- ischaemia
    • retinal emboli
    • flame haemorrhages
  14. Prognosis for BRAO?
    • retainVF defect
    • VA may recover
    • poor unless obstruction relieved within hours
  15. Ocular ischaemic syndrome characteristics?
    • uni
    • ant + post eye
    • >65 YO
    • M
  16. Sx of OIS?
    • gradual loss of VA~ months
    • dull ache over brow
  17. Ant signs of OIS?
    • diffuse episcleral injection
    • corneal edema
    • flare
    • iris atrophy
    • cataract: advanced
  18. Post signs of OIS?
    • venous dilation~ tortuosity
    • proliferative retinopathy NVD
    • dot/blot haem
    • cherry red spot
    • CWS
  19. FA of OIS?
    • delayed patchy filling
    • retinal capillary nonperfusion
    • late leakage
    • prominent arterial staining
  20. DDX of OIS?
    • Non- ischaemic CRVO: yes- uni, haem, cws, venous dilation, no - flame and disc edema
    • DiaRet: yes - dotblot, venous tortuosity no- bi hard exudates
    • HypRet: yes - arterial attenuation, focal constriction, haem, no- bi, no venous changes
  21. GCA?
    • narrowing of vessel lumina
    • inflammatory cell infiltration
    • W
    • 65-80YO
  22. Things to look for in GCA?
    • HA
    • scalp tenderness
    • thickended temporal arteries
    • jaw hurts movement
    • weightloss, anorexia, fever, night sweats, depression
    • acute VA bi loss
  23. What to do when GCA?
    emergency!

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