Reversed flow through the Ophthalmic Artery as a cause of Rubeosis Iridis

Abstract

Case 1—A 58-year-old white man was first seen two months prior to admission with a one-week his­ tory of tearing in the left eye. Two days after the onset of symptoms, the eye became red and painful. The pain and tearing subsided spontaneously in two days but the redness continued. Examination one week after the beginning of symptoms revealed a normal right eye with visual acuity correctable to 20/20. The left eye was correctable to 20/50. There was a 2-freticulate injection of the conjunctiva, the cornea was steamy, and the anterior chamber was of average depth. The pupil was reactive but the iris stroma was covered with small, newly formed blood vessels. The left lens was clear and the optic nerve re­ vealed a slight pallor. A small flame-shaped hemor­ rhage was present at 2 o'clock on the disk border. There was no other evidence of retinopathy. Gonioscopy revealed intermittent trabecular synechiae with 4 + neovascularization of the angle. By applanation tonotnetry the intraocular pres­ sure measured 12 mm Hg in the right eye and 18 mm Hg in the left eye. The right coefficient of out­ flow was not determined because of poor fixation. The left coefficient of outflow was 0.04 mmVmin/mm Hg. The central visual fields were normal to 2/1000 white. The left eye was treated with topical dexamethasone and remained comfortable. The central visual acuity ranged between 20/50 and 20/100 and the intraocular pressure varied between 18 and 28 mm Hg, as determined by applanation tonometry. The clinical impression at that time was that this represented an occlusion of the long posterior cili­ ary arteries and an impending central retinal artery