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Retinal artery occlusion
There are two types of vessels in the retina - arteries and veins. A retinal artery occlusion(RAO) is a blockage of one or many arteries/arterioles in the retina. This blockage can result from a clot blocking the vessel lumen or cholesterol lining the vessel wall and eventually blocking it. It can also be considered as a stroke (called by many as an ‘eye stroke’)..
It is an ophthalmic emergency and needs urgent treatment.
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Central Retinal Artery Occlusion (CRAO)
Branch Retinal artery Occlusion (BRAO)
what are the Types of Retinal artery Occlusions?
RAOs can be divided into two types depending on the type of vessel blocked.
Blockage of smaller arteries (arterioles) results in a Branch Retinal artery Occlusion (BRAO).
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Occlusion of the major retinal artery I.e. central retinal artery results in Central Retinal Artery Occlusion (CRAO).
Risk Factors for Retinal artery Occlusion
Systemic risk factors include:
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High blood pressure
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Uncontrolled blood sugar
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Elevated cholesterol
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Smoking
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Coronary artery disease
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Carotid artery stenosis
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Cardiac arrhythmias
Other risk factors include:
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Inflammation in the vessel walls
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Coagulation disorders
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Leukemias/Lymphomas
symptoms of Retinal Artery Occlusion
A patient with RAO usually presents with an acute painless loss of vision.
In case of CRAO - total loss of vision occurs.
In case of BRAO, the patient usually develops a black or blind spot or scotoma in the visual field.
Retinal Artery Occlusion diagnosis
In case someone develops the above symptoms, they should contact an ophthalmologist immediately and avoid any delay in initiating treatment. Diagnosis involves:
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Comprehensive dilated retina exam
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Fundus fluoroscein angiography (FFA)
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Optical Coherence Tomography (OCT)
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Fundus Photograph
Other investigations including a full systemic workup and a cardiologist and/ or neurologist are also suggested. Tests like ECG, Echocardiography, blood investigations, carotid doppler (ultrasound of the neck vessels) to rule out systemic risk factors.
Treatment Of Retinal artery Occlusion
RAO is an emergency and needs immediate intervention.
If initiated early (within a few hours), there is a chance that the retinal perfusion may be restored to some extent.
However the prognosis remains guarded as most patients do not reach a doctor early.
Treatment modalities include :
Lowering the eye pressure using IOP lowering drugs
Digital ocular massage
Draining fluid from the anterior chamber of the eye to induce hypotony - in order to dislodge any clot if present
Further treatment including vitrectomy has been tried in a few patients under guarded prognosis.
Hyperbaric oxygen therapy is being tried as a newer modality to help treat recent CRAO.
Your cardiologist or neurologist may start blood thinner and cholesterol lowering agents as well.
Prevention of Retinal Artery Occlusion
RAO is unpredicatable and no one can prevent its occurrence.
However, a good metabolic control of blood pressure, blood sugar and cholesterol goes a long way in preventing such serious conditions.
Avoidance of smoking is a major factor which is known to reduce the risk of RAO.
A healthy lifestyle, regular exercise and frequent follow ups are important ways by which one can maintain a healthy eyesight and long life.
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