Retinal artery occlusion

Central retinal artery – majority of inner retina blood circulation.

Cilioretinal artery – 15-30% of the circulation. (cilioretinal artery occlusion happens about 5% cases – watch out for GCA).


Branch retinal artery occlusion (BRAO)

  • 40% of cases.
  • Retinal emboli is the cause.
  • Painless loss of vision – 3/4 has 6/12 vision or better.
  • Sectoral retinal opacification with retinal oedema.
  • Monitor for iris neovacularisation (rare).

Central retinal artery occlusion (CRAO)

  • Elderly male.
  • Bilateral cases 1-2%.
  • Sudden painless loss of vision +/- amaurosis fugax.
  • RAPD present
  • Rubeosis usually within 4-5 weeks (20% cases).
  • Cherry red spot at fovea (cilioretinal artery patent), retinal whitening, arterial attenuation, cattle tracking (emboli), ONH oedema (think of AION).

Management:

  1. Rule out GCA – FBC / ESR / CRP / Temporal artery biopsy / steroids Rx.
  2. Carotid Doppler USS
  3. Referral to TIA clinic
  4. Young patients – hypercoagulable cause – blood test for homocysteine, sickle cell, Factor V Leiden, protein C & S, antithrombin III and antiphospholipid antibody.
  5. Conservative treatment
  6. Active treatment – window of 4 hours (irreversible damage after onset – retina can withstand ischaemia without damage up to 97 minutes after onset of CRAO) – ocular massage or AC paracentesis to dislodge emboli.

Location Birmingham Midlands Eye Centre 76 Dudley Road Birmingham B18 7QH UK Phone 0121 554 3801 Hours Mr Ch'ng | Vitreoretinal Clinic Sessions: Monday: 8.30am - 12.30pm Wednesday (alternate): 8.30am - 5.00pm Thursday: 8.30am - 12.30pm Friday: 8.30am - 12.30pm | Vitreoretinal Theatre Sessions: Wednesday (alternate): 8.30am - 5.00pm & Friday (emergency cases): 1.30pm - 5.00pm | Eye Casualty Session: Monday 1.00pm - 4.30pm |
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