Ocular ischemic syndrome, central retinal artery obstruction, and branch retinal artery obstruction 1,2

Abstract

Ocular ischemic syndrome is a condition characterized by visual loss described mainly in males 50 years and older secondary to carotid artery stenosis or occlusion. Loss of vision results from chronic ischemic changes to the anterior and posterior segments of the eye. Pain around the eye has been reported in up to 40% of the patients. Also, these patients may report difficulty adjusting to a darker environment after light exposure. Neovascularization of the iris and retina is common. Associated systemic conditions include arterial hypertension, coronary artery disease, diabetes mellitus, cerebrovascular disease and tobacco use. Digital subtraction angiography can demonstrate carotid artery obstruction in the majority of patients, however less invasive procedures such as contrast enhanced MR angiography in combination with duplex ultrasound correlates with the degree of carotid stenosis. Carotid endarterectomy in addition to management of neovascularization of iris or retina is the treatment of choice, however, the prognosis for visual recovery is still limited. Acute retinal arterial obstruction is a dramatic and usually irreversible painless loss of vision that can involve the central retinal artery or an arterial branch, most commonly secondary to cerebrovascular and cardiovascular disease. Other associated conditions include various hematological, infectious and metabolic abnormalities. In central retinal artery occlusion a common finding includes a cherry red spot in the macula. A careful evaluation of all potential sources of emboli is essential in this condition since there is a strong association with fatal outcome due to cardiovascular disease and stroke. Other etiologies such as coagulopathies, collagen vascular diseases and viral infections have been identified in patients with retinal arterial obstructions. Despite aggressive intervention the visual prognosis of central retinal artery occlusion remains poor.