Retinal Vascular Occlusion

1. Retinal Vascular Occlusion
•Arterial
•Venous
Jonathan Sookdeo
Ophthalmology Presentation

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3. 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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4. 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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5. Normal Retina
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6. Retinal Artery Occlusion
Central 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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7. 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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8. Central Retinal Artery Occlusion
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Branch Retinal Artery Occlusion

9. 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

10. Retinal Venous Occlusion
• Treatment
▫ Treat existing risk factors
▫ Treat the macular edema, retinal
neovascularization
▫ Anterior segment neovascularisation
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11. Central Retinal Venous Occlusion
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Branch Retinal Venous
Occlusion

12. 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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