Relation between Retinal Arterial Occlusions in the Eye and Carotid Artery Occlusion - A Retrospective Study in a Tertiary Care Hospital in Kottayam in Kerala

BACKGROUND Central retinal artery occlusion (CRAO) was first described by Van Graefe in 1859 as an embolic event to the central retinal artery in a patient with endocarditis. CRAO has various causes, but patients typically present with sudden, severe, and painless loss of vision. Retinal arterial occlusions are a cause for profound visual loss in the population. Carotid atherosclerosis is common in elderly people. Dyslipidaemia, hypertension, and diabetes mellitus are factors which accelerate the development of carotid atheromatous plaques. Embolism from the carotid bifurcation is the most common cause of retinal artery occlusions. In retinal arterial occlusion carotid arterial occlusion is usually assessed using radiological techniques. The purpose of this study was to evaluate carotid atherosclerotic disease in patients with arterial occlusions in the eye and determine the relation between arterial occlusions in the eye & carotid artery occlusive disease. METHODS This retrospective study included patients aged thirty and above, who had come with symptoms suggestive of arterial occlusions in the eye and carotid doppler was done. The inclusion criteria included patients diagnosed with the following conditions CRAO, branch retinal artery occlusion (BRAO), ophthalmic artery occlusion, anterior ischaemic optic neuropathy (AION) and cilioretinal artery occlusion. Patients usually present with sudden loss of vision in one eye. After taking a detailed history, all patients were subjected to a thorough ocular examination. Patient’s vision is assessed using Snellen’s visual acuity chart, pupillary assessment done, and fundus examination to look for retinal arterial occlusion is also done. Fundus imaging is also done. Carotid doppler was done to rule out carotid artery occlusive disease. RESULTS Patients presenting with retinal arterial occlusion should be investigated thoroughly for both systemic and local causes of CRAO. The risk of developing arterial occlusions were 1.7 - 9.15 times more in patients with carotid artery occlusion than in patients with normal carotids. Arterial occlusion was more found in patients with 70 % occlusion of the carotid artery. CONCLUSIONS There was a strong association between retinal arterial occlusions and carotid artery occlusion. KEYWORDS Central Retinal Artery Occlusion (CRAO), Carotid Artery Occlusive Disease, Carotid Doppler

Awareness and knowledge of emergent ophthalmic diseases among non medical students

This study was done to assess the awareness and knowledge of 3 emergent ophthalmic diseases - retinal detachment, central retinal arterial occlusion, acute angle closure glaucoma among non medical students. It is important to assess their spectrum and presentation to prevent irreversible blindness. A questionnaire based study was done among 201 non medical students to assess their knowledge about these emergent ophthalmic diseases. It includes one (yes/no) question for assessing the awareness. To test the knowledge, 3 questions were asked regarding symptoms treatment and complications separately for every emergent ophthalmic disease. Analysis was done using google forms in this study. Descriptive statistics were represented using bar graphs and tables for better understanding. A total of 201 non medical students were enrolled in this study. The mean age was 23.24 approximately. Only 42 of 201 were aware of acute angle closure glaucoma (20.9%) and 44 (29.1%) were aware of retinal detachment. There was not much difference in level of awareness between these two conditions but it was significantly lower in case of CRAO. Only 27(13.4%) of 201 were aware about CRAO. Almost 85.6% were not aware about the blindness caused by CRAO, 81.6% were not aware about the blindness caused by RD and 79.1% were not aware about the blindness caused by AACG. In this study we found that level of awareness and knowledge of emergent ophthalmic diseases were very low among non medical students. Hence, efforts should be made to promote health education regarding these ocular emergencies. This will not only help the young people to screen themselves promptly but also spread awareness about these conditions to their friends and relatives.

Retinal arterial occlusion with multiple retinal emboli and carotid artery occlusion disease. Haemodynamic changes and pathways of embolism

ObjectiveTo introduce a special subgroup, retinal artery occlusion (RAO) with multiple emboli, which is highly associated with ipsilateral carotid artery occlusion disease (CAOD).Methods and analysisThis is a cohort study. Cases of RAO with multiple retinal emboli were consecutively enrolled. All patients underwent at least one of the carotid/cerebral evaluations: carotid arteriography, orbital/carotid colour Doppler ultrasonography and CT angiography to demonstrate haemodynamic changes and to discuss possible mechanisms and pathways of the emboli.ResultsAmong 208 RAO eyes, 12 eyes (5.7%) in 11 patients had multiple emboli were recruited in this study. Eleven eyes (91.6%) had ipsilateral carotid plaques and atherosclerosis with high-grade stenosis; among them, five were total carotid occlusion. Haemodynamic changes were found in nine patients with RAO (81.8%) with carotid stenosis 60% or greater. Most compensatory intracranial circulations were re-established via the circle of Willi with antegrade ophthalmic flows, but the direction of ophthalmic flow reversed in three eyes indicating the recruitment of external collaterals. Two cases underwent carotid stent successfully.ConclusionRAOs with multiple emboli are rare but highly associated with severe CAOD with haemodynamic flow changes, warning critical condition in carotid/cerebral circulations. Either direct embolism from the carotid or cardiac lesions or indirect embolism via the collateral pathways is the mechanism of pathogenesis. Immediate action should start to manage these patients to prevent further deterioration.