Retinal Vascular Occlusion•Arterial•Venous

Jonathan Sookdeo

Ophthalmology Presentation

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Arterial supply of the Retina

•Ophthalmic artery splits into ciliary and central retinal artery (CRA).

•Inner retina is supplied by branches of the CRA

•Outer Retina and macula supplied by the Ciliary artery.

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Venous Drainage of the Retina

•Retinal venules and veins forms the central retinal vein, which exits the eye with the optic nerve.

•It runs parallel and counter-current to the central retinal artery.

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Normal Retina

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Retinal Artery OcclusionCentral Branch

Etiology Embolism, atherosclerotic changes, inflammatory endarteritis, angiospasm.

Same as Central with the embolus in a more distal part of the artery

Clinical Features Acute persistent painless loss of vision, relative afferent pupillary defect occurs, ischemic retinal whitening, A "cherry red spot" appears in the macula

A sectional visual field defect,

less than half of patients have impaired visual acuity.

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Retinal Artery Occlusion

Treatment▫Occular Massage

▫Anterior Chamber Paracentesis if <24hrs

▫Thrombolytics may be useful if initiated within 4-6 hours of visual loss

▫Hyperbaric Oxygen therapy

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Central Retinal Artery Occlusion

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Branch Retinal Artery Occlusion

Central Branch

Etiology Associated with Primary Thrombus Formation

Related to compression of the branch veins by retinal arterioles at the arteriovenous crossing points

Clinical Features

Acute onset of blurred vision in one eye.

Seldom asymptomatic.

Leads to neovascular glaucoma and thereby, a painful eye.

Later, retinal hemmorrhage, edema, dilated retinal veins and possibly cotton wool spots

Asymptomatic

Diagnosed on routine exam

Scotoma or visual field deficit with blurred or gray vision corresponding to the area of retinal vein occlusion.

Blurred central vision if affecting the macula

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Retinal Venous occlusion

Retinal Venous Occlusion

•Treatment▫Treat existing risk factors▫Treat the macular edema, retinal

neovascularization▫Anterior segment neovascularisation

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Central Retinal Venous Occlusion

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Branch Retinal Venous Occlusion

References• "Retinal Artery Occlusion ." Retinal Artery Occlusion. Web. 14 Jan. 2015.

<http://emedicine.medscape.com/article/799119-overview>.

• "Retinal Artery Occlusions." Retinal Artery Occlusions. Web. 14 Jan. 2015. <http://www.williamsoneyeinstitute.com/retina-center/retinal-artery-occlusions>.

• "Retinal Vein Occlusion ." Retinal Vein Occlusion. Web. 14 Jan. 2015. http://emedicine.medscape.com/article/798583-overview

• Kiel, Jeffrey. Anatomy. U.S. National Library of Medicine. Web. 14 Jan. 2015. <http://www.ncbi.nlm.nih.gov/books/NBK53329/>.

• "Anti-vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema." Web. 14 Jan. 2015. <http://www.medscape.com/viewarticle/817758>.

• "Treatment of Diabetic Retinopathy and Macular Edema." All About Vision. Web. 14 Jan. 2015. http://www.allaboutvision.com/conditions/diabetic-treatment.htm

• Farahvash MS, Moghaddam MM, Moghimi S, et al. Dalteparin in the management of recent onset central retinal vein occlusion: a comparison with acetylsalicylic acid. Can J Ophthalmol. Feb 2008;43(1):79-83.

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