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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