Chapter 029. Disorders of the Eye (Part 10) potx

Disorders of the Eye Part 10 Central retinal artery occlusion combined with ischemic optic neuropathy in a 19-year-old woman with an elevated titer of anticardiolipin antibodies.. Note

Chapter 029 Disorders of the Eye

(Part 10)

Central retinal artery occlusion combined with ischemic optic neuropathy in a 19-year-old woman with an elevated titer of anticardiolipin

antibodies Note the orange dot (rather than cherry red) corresponding to the fovea and the spared patch of retina just temporal to the optic disc

Figure 29-7

Hypertensive retinopathy with scattered flame (splinter) hemorrhages and cotton-wool spots (nerve fiber layer infarcts) in a patient with headache and a

blood pressure of 234/120

Impending branch or central retinal vein occlusion can produce prolonged

visual obscurations that resemble those described by patients with amaurosis fugax The veins appear engorged and phlebitic, with numerous retinal hemorrhages (Fig 29-8) In some patients, venous blood flow recovers spontaneously, while others evolve a frank obstruction with extensive retinal bleeding ("blood and thunder" appearance), infarction, and visual loss Venous occlusion of the retina is often idiopathic, but hypertension, diabetes, and glaucoma are prominent risk factors Polycythemia, thrombocythemia, or other factors leading to an underlying hypercoagulable state should be corrected; aspirin treatment may be beneficial

Figure 29-8

Central retinal vein occlusion can produce massive retinal hemorrhage ("blood and thunder"), ischemia, and vision loss

Anterior Ischemic Optic Neuropathy (AION)

This is caused by insufficient blood flow through the posterior ciliary arteries supplying the optic disc It produces painless, monocular visual loss that is usually sudden, although some patients have progressive worsening The optic disc appears swollen and surrounded by nerve fiber layer splinter hemorrhages (Fig 29-9) AION is divided into two forms: arteritic and nonarteritic The nonarteritic form of AION is most common No specific cause can be identified, although diabetes and hypertension are frequent risk factors No treatment is available About 5% of patients, especially those over age 60, develop the arteritic form of AION in conjunction with giant cell (temporal) arteritis (Chap 319) It is

urgent to recognize arteritic AION so that high doses of glucocorticoids can be instituted immediately to prevent blindness in the second eye Symptoms of polymyalgia rheumatica may be present; the sedimentation rate and C-reactive protein level are usually elevated In a patient with visual loss from suspected arteritic AION, temporal artery biopsy is mandatory to confirm the diagnosis Glucocorticoids should be started immediately, without waiting for the biopsy to

be completed The diagnosis of arteritic AION is difficult to sustain in the face of

a negative temporal artery biopsy, but such cases do occur rarely

Figure 29-9

Anterior ischemic optic neuropathy from temporal arteritis in a 78-year-old woman with pallid disc swelling, hemorrhage, visual loss, myalgia, and an erythrocyte sedimentation rate of 86 mm/h