Ophthalmology KFP 2.5 – Harry has painless unilateral vision loss

by | Jan 23, 2018

Harry is a 70 year old man presented with acute persistent painless unlilateral loss of vision, starting like a curtain descending. He can barely see his hand in his right eye. He has a history of hypertension, diabetes, hyperlipidemia and AF.

What are the features of fundoscopy you see in the above picture?

  1. Cherry Red spot on fovea
  2. Pale retina

What are the differentials of the above presentation?

  1. retinal artery occlusion
  2. retinal detachment
  3. Amaurosis Fugax
  4. retinal vein occlusion
  5. Stroke
  6. Vitreous Haemorrhage

What are the key features of history that would allow you to differentiate between causes of Harry’s presentation?

  1. History of diabetes
  2. History of recent trauma
  3. Cardiovascular history
  4. neurological symptoms
  5. History of AF

You are considering a diagnosis of Central Retinal Artery Occlusion. What are the key history feature of retinal artery occlusion?

  1. Sudden loss of vision like curtain descending
  2. Painless
  3. Unilateral
  4. Sudden
  5. Central vision lost
  6. Not improved 1mm pinhole
  7. No light perception

What are the Causes and associations of Retinal Artery Occlusion?

  1. Cardiovascular risk factors
  2. HTN
  3. Diabetes
  4. Hyperlipidaemia
  5. AF
  6. Atherosclerosis
  7. SLE in younger patients
  8. Wegeners Granulomatosis
  9. Behcets Disease
  10. GCA
  11. Hypercoaguable state

What are the key fetaures of examination in central retinal artery occlusion?

  1. VA not improved with 1mm pinhole
  2. VA markedly reduced
  3. retinal arteries emboli
  4. Red reflex abnormal and asymmetrical
  5. Cherry red spot on macula
  6. Relative afferent pupillary defect
  7. Attenuated arterioles
  8. Pale retina due to ischemia

What is the source of the emboli in central retinal artery occlusion?

  1. Carotids
  2. Heart Valves

What is the immediate managament of this condition?

  1. Urgent referral for treatment within 4 hours

What are the immediate steps in Managament of central retinal artery occlusion?

  1. Referral to ophthalmologist
  2. High flow inhaled 100% O2
  3. IV corticosteroids
  4. Massage globe digitally though closed eye closed within 30 min
  5. Anterior Chamber Paracentesis by eye surgeon
  6. Hyperbaric oxygen within 12 hours
  7. IV Acetazolamide 500mg to reduce IOP
  8. Timolol 0.5% topical drops BD to reduce IOP

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