Ocular ischemic syndrome

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Ocular ischemic syndrome
SpecialtyOphthalmology Edit this on Wikidata

Ocular ischemic syndrome is the constellation of ocular

anterior segment usually seen in post-surgical cases. Retinal artery occlusion (such as central retinal artery occlusion or branch retinal artery occlusion
) leads to rapid death of retinal cells, thereby resulting in severe loss of vision.

Symptoms and signs

Those with ocular ischemic syndrome are typically between the ages of 50 and 80 (patients over 65);

diabetes mellitus, coronary artery disease, previous stroke, and hemodialysis.[4][5]

The condition presents with visual loss secondary to hypoperfusion of the eye structures. The patient presents with intractable pain or ocular angina. On dilated examination, there may be blot retinal hemorrhages along with dilated and beaded retinal veins. The ocular perfusion pressure is decreased. The corneal layers show edema and striae. There is mild anterior uveitis. A cherry-red spot may be seen in the macula, along with cotton-wool spots elsewhere, due to retinal nerve fiber layer hemorrhages. The retinal arteries may show spontaneous pulsations.[citation needed]

Complications

If carotid occlusive disease results in ophthalmic artery occlusion, general ocular ischemia may result in retinal neovascularization, rubeosis iridis, cells and flare, iris necrosis, and cataract. The condition leads to neovascularization in various eye tissues due to the ischemia. The eye pressure may become high due to associated

neovascular glaucoma. An ischemic optic neuropathy
may eventually occur.

Causes

Severe ipsilateral or bilateral carotid artery stenosis or occlusion is the most common cause of ocular ischemic syndrome.[1] The syndrome has been associated with occlusion of the common carotid artery, internal carotid artery, and less frequently the external carotid artery.[6] Other causes include:

Diagnosis

Differential diagnoses

  • Central retinal vein occlusion
  • Diabetic retinopathy: The presence of retinal hemorrhages, particularly in those who have diabetes, may also be caused by diabetic retinopathy.[9] Given the bilateral nature of diabetic retinopathy, however, one should suspect ocular ischemic syndrome when retinal ischemia is unilateral.[10]

Treatment

Quick determination of the cause may lead to urgent measures to save the eye and life of the patient. High clinical suspicion should be kept for painless vision loss in patients with

deep venous thrombosis, atrial fibrillation, pulmonary thromboembolism or other previous embolic episodes. Those caused by a carotid artery embolism or occlusion have the potential for further stroke by detachment of embolus and migration to an end-artery of the brain.[11] Hence, proper steps to prevent such an eventuality need to be taken.[citation needed
]

Retinal arterial occlusion is an ophthalmic emergency, and prompt treatment is essential. Completely anoxic retina in animal models causes irreversible damage in about 90 minutes. Nonspecific methods to increase blood flow and dislodge emboli include digital massage, 500 mg

IV acetazolamide and 100 mg IV methylprednisolone (for possible arteritis). Additional measures include paracentesis of aqueous humor to decrease IOP acutely. An ESR should be drawn to detect possible giant cell arteritis. Improvement can be determined by visual acuity, visual field testing
, and by ophthalmoscopic examination.

At a later stage, pan-retinal photocoagulation (PRP) with an argon laser appears effective in reducing the neovascular components and their sequelae.

The visual prognosis for ocular ischemic syndrome varies from usually poor to fair, depending on speed and effectiveness of the intervention. However, prompt diagnosis is crucial as the condition may be a presenting sign of serious cerebrovascular and ischemic heart diseases.[5]

In 2009, the

hyperbaric oxygen (HBO).[12][13] When used as an adjunctive therapy, the edema reducing properties of HBO, along with down regulation of inflammatory cytokines may contribute to the improvement in vision.[14] Prevention of vision loss requires that certain conditions be met: the treatment be started before irreversible damage has occurred (over 24 hours), the occlusion must not also occur at the ophthalmic artery, and treatment must continue until the inner layers of the retina are again oxygenated by the retinal arteries.[15]

References

  1. ^
    PMID 10546383
    .
  2. ^ Friedberg MA, Rapuano CJ. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, J.B. Lippincott, 1994.
  3. ^ a b "Ocular Ischemic Syndrome." Archived 2009-09-27 at the Wayback Machine Accessed October 25, 2006.
  4. PMID 11601190
    .
  5. ^
    PMID 9160035
    .
  6. PMID 16340491
    .
  7. PMID 16944156
    .
  8. PMID 1598963
    .
  9. PMID 16138965
    .
  10. PMID 16465117
    .
  11. PMID 11336956
    .
  12. ^ The Undersea and Hyperbaric Medical Society (UHMS), Hyperbaric Oxygen Therapy Committee. Guidelines: Indications for Hyperbaric Oxygen. Durham, NC: UHMS; 2009.
  13. PMID 19024664. Archived from the original on January 13, 2013. Retrieved 2010-11-09.{{cite journal}}: CS1 maint: unfit URL (link
    )
  14. PMID 18019081. Archived from the original on January 13, 2013. Retrieved 2009-05-26.{{cite journal}}: CS1 maint: unfit URL (link
    )
  15. ^ Butler Jr, FK (2010). "Hyperbaric oxygen for central retinal artery occlusion". Wound Care & Hyperbaric Medicine. 1 (3): 25.

External links

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