Abrupt loss of vision: Retinal artery occlusion

2022 ◽  
Vol 26 ◽  
pp. 101266
Author(s):  
María José Vicente Altabás ◽  
Borja Arias-Peso ◽  
María Amparo Vicente Altabás
2021 ◽  
Vol 2021 (6) ◽  
Author(s):  
Gregory M Taylor ◽  
Daniel Evans ◽  
Robert P Doggette ◽  
Ryan C Wallace ◽  
Andrew T Flack ◽  
...  

ABSTRACT Point-of-care ultrasound (POCUS) has become an essential part of the evaluation of vision loss among emergency physicians in the emergency department (ED). It is frequently used to evaluate for vitreous hemorrhage, foreign bodies, retinal detachment, optic neuritis and posterior vitreous detachment; however, it can also be used to evaluate for a central retinal artery occlusion (CRAO). A POCUS can reveal a hyperechoic density in the optic nerve sheath just proximal to the retinal surface, and this is referred to as a retrobulbar ‘spot sign’ (RBSS). We present the case of an 88-year-old male that presented to our community ED with a painless loss of vision to his right eye. A POCUS revealed an RBSS of the central retinal artery and he was subsequently diagnosed with a CRAO. At his 1-month follow-up, he has regained light perception and 15% of his vision, however, remains with significant visual impairment.


The Lancet ◽  
2021 ◽  
Vol 397 (10268) ◽  
pp. e1
Author(s):  
Maxime Guillaume ◽  
Agnes Lahary ◽  
Linda Zourdani ◽  
Edouard Malandain ◽  
Ozlem Ozkul-Wermester

2014 ◽  
Vol 71 (11) ◽  
pp. 1072-1077 ◽  
Author(s):  
Horia Stanca ◽  
Zarko Petrovic ◽  
Mihnea Munteanu

Introduction. Central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO) result in partial or complete retinal ischemia and sudden loss of vision; at this moment, there is no effective therapy for CRAO and BRAO. Transluminal Nd:YAG laser embolysis (TYE) represents a therapeutic approach used for retinal vascular occlusive diseases. The main indication is branch retinal artery occlusion with visible embolus; for central retinal artery occlusion this tehnique is hardly applicable. The principle of this method consists of intravascular embolus breakage using the 1064 nm Nd:YAG laser, focused on the embolus surface. Case report. We presented 5 cases with BRAO, 3 with infero-temporal and 2 with supero-temporal BRAO, all of them treated with TYE, with variable results. All the patients had a visible embolus within the BRA, the laser applications being delivered directly to the embolus. Conclusion. Despite our short-term experience regarding this therapeutical approach, we can resume that the moment of emboli distruction, as close as possible to the onset of the occlusion, is decisive for regaining vision and that applying the procedure correctly is superior to observation in most cases. Worldwide experience with TYE is still limited, but the technique seems feasible also when treating CRAO caused by visible emboli on the optic disc surface. This most certainly calls for random trials for identifying precisely the role of TYE in treatment of retinal occlusion pathology, though the relatively small number of properly diagnosed cases affects this objective. In all cases, the risks of TYE must be weighed against the possibility of severe and permanent loss of vision secondary to retinal artery occlusions.


2016 ◽  
Vol 7 (2) ◽  
pp. 191-193 ◽  
Author(s):  
Amit Raj ◽  
Sudesh Kumar Arya ◽  
Sunandan Sood

Background: Blindness after spinal surgery is a rare complication, but it is serious, irreversible and incurable. Central retinal artery occlusion (CRAO) is rare after spinal surgery and ophthalmoplegia is even rarer. Case: A 52-year-old male patient complained of loss of vision in right eye immediately after cervical spine surgery. On examination, the patient’s visual acuity in right eye was absent perception of light. Right eye pupil was dialated and relative afferent pupillary defect (RAPD) was present. Extraocular movements were absent in all gazes in right eye. Intra-ocular pressure (IOP) was 26 mmHg in right eye and 16 mmHg in the left. Posterior segment examination revealed blurred disc margin with ischemic whitening of retina, thin and attenuated retinal arterioles and a central cherry red spot in right eye. Left eye was essentially normal. Observations: The causal factors of blindness in the patient were likely ischemia of the retina after venous congestion or temporary arterial occlusion resulting from changes in pressure to the tissues of the orbit. Factors including prolonged prone positioning with head end dependent position and possibility of orbital compression by the headrest could have contributed to impaired venous drainage, increase in IOP and reduction in perfusion pressure. Conclusion: Loss of vision post spinal surgery is a rarest of complication yet grave and irreversible. Because the problem involves mainly prone positioning of the patient, an appropriate position should be found so that facial and ocular compression can be avoided.


2014 ◽  
Vol 3 (9) ◽  
Author(s):  
L. Rezaei ◽  
H. Ghanbari ◽  
M. Taghaodi ◽  
M. Malekahmadi ◽  
M. Adinevand ◽  
...  

Author(s):  
Shivcharan Lal Chandravanshi, Sunil Kumar Shrivastava, Priyanka Agnihotri, Smriti Gupta

Aims and Objective - The aim of the present study is to identify risk factors associated with different retinal vascular occlusive diseases (RVOD), such as central retinal artery occlusion (CRAO), hemi-retinal artery occlusion (HRAO), branch retinal artery occlusion (BRAO), cilioretinal artery occlusion (Cilio-RAO), central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and hemi-retinal vein occlusion (HRVO). Patients and Method - A cross-sectional study on 114 consecutive subjects, aged 24-96 years who have attended at the outpatient department of ophthalmology at Shyam Shah Medical College, Rewa, MP, were included in the study. The Duration of study was January 2016 to December 2017. Only patients with CRAO, BRAO, HRAO, Cilio-RAO, CRVO, BRVO, and HRVO were included in the study. Other retinal vascular disorders such as diabetic vaso-occlusive disease, anterior and posterior ischemic and non-ischemic neuropathy, hypertensive retinopathy, sickle cell retinopathy, retinal telangiectasia, retinopathy of prematurity, were excluded from study. Results - We have included 114 patients, 64 cases (56.14%) males, 50 (43.85%) females, aged 56+/-8 years (range 24-96 years).  Bilateral retinal vascular occlusive disorders were seen in only 4 cases (3.5%). Two patients have bilateral CRVO followed by one case of bilateral BRVO and one case of bilateral CRAO.  Out of 114 patients, branch retinal vein occlusion was seen in 62 cases (54.38%), followed by central retinal vein occlusion in 36 cases (31.57%), CRAO in 8 cases (7.01%), and hemi- retinal vein occlusion in 4 cases (3.50%). Hypertension was the most common, (40 cases, 35.08%) risk factor identified for retinal vascular occlusive disorders followed by diabetes 24 cases (21.05%), combined diabetes and hypertension in 22 cases (19.29%), and atherosclerosis in 18 cases (15.78%). Conclusions - Retinal vascular occlusive diseases have systemic as well as ocular risk factors. Understanding of these risk factors is essential for proper treatment of RVOD. Timely identification of risk factors for RVOD may helpful in decreasing ocular and systemic morbidity in these patients.


2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Grayson Roumeliotis ◽  
Stewart Campbell ◽  
Sumit Das ◽  
Goran Darius Hildebrand ◽  
Peter Charbel Issa ◽  
...  

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Timothy M. Janetos ◽  
Olga German ◽  
Rukhsana Mirza

Abstract Background A central retinal artery occlusion (CRAO) is an ophthalmic emergency due to its strong association with cerebrovascular and cardiovascular morbidity and mortality. A timely diagnosis is necessary but difficult in the setting of dense asteroid hyalosis, as typical fundoscopic findings can be obscured. We present a case where multimodal imaging in an eye with an obscured fundus could lead to timely diagnosis and management of CRAO in a patient with acute vision loss. Case presentation A 94-year-old Caucasian woman with a history of exudative macular degeneration presented to the retina clinic with acute vision loss in one eye over the course of an afternoon. The patient had dense asteroid hyalosis, and a direct retinal exam was not possible. Multimodal imaging suggested a CRAO diagnosis. The patient received digital ocular massage directly prior to undergoing fluorescein angiography (FANG), which confirmed the diagnosis. The patient was transported from clinic to the emergency room for an emergency stroke workup, which revealed a spontaneous echo in the left atrial appendage, and the patient was started on antiplatelet therapy. When she presented for follow-up within a week, the patient noted that her vision had improved at the time of digital ocular massage and continued to improve thereafter. Her FANG showed marked reperfusion of the retina, and she subsequently has completely regained her baseline visual acuity. Conclusions Multimodal imaging is useful in evaluating visual loss in patients with acute vision loss. In addition, ocular massage is a simple, low-risk intervention that may have benefit in the treatment of acute CRAO. Patients who present to ophthalmologists with an acute CRAO need an emergency referral for evaluation of cerebrovascular and cardiovascular comorbidities.


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