Central Retinal Vein Occlusion Differential Diagnosis

Central Retinal Vein OcclusionDifferential Diagnosis

Differential diagnosis

• DM retinopathy• Ocular Ischemic Syndrome• Anterior Ischemic Optic Neuropathy

Diabetic Retinopathy

• Ocular manifestation of Diabetes Melitus• 80% affected of those with DM > 10 years• Result of microvascular retinal changes– Intramural pericyte death and basement

membrane thickening– Incompetence of vascular walls

Diabetic Retinopathy• Signs and symptoms:– Hemorrhages (dot blot, – flame-shaped, pre-retinal, vitreous)– Venous beading, IRMA– Cotton wool spots– Exudates– Macular edema

Ocular Ischemic Syndrome

• Constellation of ocular signs and symptoms secondary to severe chronic arterial hypoperfusion to the eye

• Onset: 50 – 80 years old• Men affected twice as much as women• May present with history of other systemic

disease: hypertension, DM, CAD

Ocular Ischemic Syndrome• Signs and symptoms– 90% presents with visual loss– May have dull, radiating eye pain– Fundus exam: dot blot hemorrhages, cotton wool

spots, retinal nerve fiber layer hemorrhages, venous beading and venous dilation

Ocular Ischemic Syndrome

• Causes:– Most common: ipsilateral/bilateral carotid artery

stenosis or occlusion (common carotid)– Others:• Takayasu’s arteritis• Giant cell arteritis• Severe ophtalmic artery occlusion due to

thromboembolism

Anterior Ischemic Optic Neuropathy

• Loss of vision due to damage to the optic nerve from insufficient blood supply (infarction of short posterior ciliary arteries supplying the anterior optic nerve)

• Arteritic: temporal arteritis• Non-arteritic: cardiovascular risk factors

Anterior Ischemic Optic Neuropathy

• Non-arteritic:– Risk Factors:• “crowded” disc• Cardiovascular: HPN, DM, hypercholesterolemia

Anterior Ischemic Optic Neuropathy

• Non-arteritic:– Signs and symptoms:• Onset: 50years and below• Sudden visual loss upon waking up• Optic disc swelling• 15% to 20% involvment of other eye within 5 years• (+) RAPD

Anterior Ischemic Optic Neuropathy

• Arteritic:– Temporal arteritis/ Giant Cell Arteritis– Inflammatory disease of medium sized blood

vessel– High incidence of affecting the other eye if left

untreated– Onset: >50 years old

Anterior Ischemic Optic Neuropathy

• Arteritic:– Signs and symptoms:• Constitutional signs:

– Jaw Claudication– Scalp tenderness– Weight loss, fatigue, myalgia, loss of appetite

• Elevated EST and thrombocytosis• (+) RAPD• Swollen disc• Splinter hemorrhages