• Athrosclerosis

  • Carotid artery
  • TIA unilateral blindness
  • Contralateral hemiparesis

• Vertebrobasilar system

  • TIA binocular blindness
  • Bilateral weakness and confusion

• Carotid artery disease

  • Ischemic
  • Dot-blot
  • Flame hemorrhage
  • Cotton wool
  • Silver wire
  • Gross edema
  • Decreased IOP
  • 60% develop neovascular glaucoma
  • Non-ischemic
  • Dot-blot
  • Edema

• Central retinal artery occlusion

  • Sudden painless loss of vision
  • Occludes at lamina and veins boxcar
  • Within hr’s the retina goes white with cherry spot in macula
  • Must treat within 1-2 hr’s
  • Digital massage and release
  • Breath in paper bag
  • Lower IOP
  • May still have acuity if a ciliocentral artery is present

   

• Branch retinal vein occlusion BRVO

  • Second only to diabetes in incidence
  • Age 50-60
  • Occludes at artery and venous crossing
  • 5% bilateral
  • Associated with diabetes
  • Hypertension
  • Hypercholesterol,
  • Hypertriglyceride
  • If edema in macula acuity worsens
  • 30% develop neovascularization and traction retinal detachment80% have decreased IOP
  • Photocoagulate
  • Ischemic

  • Dilated tortuous vein and dot-blot
  • Hemorrhage from site of occlusion out to periphery in that sector
  • Cotton wool and flame shaped hemorrhage later
  • Lipid infiltrates at site 2 months later

  • Non-ischemic

  • Dot-blot hemorrhage and lipid only

• Central retinal vein occlusion CRVO
  •  
  • Occludes at lamina
  • Under 50
  • Head injury
  • 50+
  • Hypertension
  • Diabetes
  • Lung Disease
  • All ages
  • Hyperviscosity syndrome
  • Hyperlipemia

• Laser photocoagulation
  • Green and blue argons
  • Retina tears, retinal hemorrhage’s, retinoschisis
  • Red krypton
  • Retina tears
  • Choroidal neovascularization

• Microscopic signs
  • Emboli
  • Microaneurysms
  • Cannot see with ophthalmoscope - Glow with fluroescein
  • Leak causing edema
  • Always present with dot-blot and hard exudates

• Macroscopic retinal signs

• Arterial signs

  • Cotton wool
  • AIDS
  • Anemia’s
  • Carotid stenosis
  • CRVO and RBVO
  • Diabetes
  • Fade to a gray granular area
  • Hypertension
  • Ischemia in superficial nerve fiber layer
  • Lasts 5-7 weeks
  • Leukemias
  • Lupus
  • Papilledema

  Flame shaped hemorrhage

  • In Henles layer
  • If white center called Roth spots
  • Diabetes
  • Endocarditis
  • Lupus
  • Hypertension
  • Diabetes
  • Anemia’s
  • Papilledema
  • BRVO and CRVO
  • Glaucoma
  • Ischemic neuropathy

  Pre-retinal hemorrhage

  • In front of retina
  • PVD
  • Hypertension
  • Diabetes
  • Anemia’s

Venous signs

• Dot-blot hemorrhage
• Within inner nuclear layer
• Diabetes
• BRVO and CRVO
• Hypertension
• Carotid stenosis

• Hard exudates

• Microaneurysms leak lipids deep in retina
• Hypoxia leads to damaged tissue
• Lipid filled macrophages migrate to outer border of damaged area
• Dr. Catania's “Circling of the wagons”
• Bad sign if in macula
• Diabetes - Circular
• Hypertension - Star
• Coats disease - Dense in periphery
• Venous occlusive disease
• Papilitis
• Papilledema

• Microaneurysms

• Exudates lead to edema
• Deep in diabetes
• Superficial in hypertension

• Soft exudates

• Choroidal neovascularization

• Gray - green
• Spread of a retinal hemorrhage
• Coats disease
• Leukemia
• Sickle cell
• Usually large, dark red with lobulated borders
• Eventually absorbed into scar tissue

• Vessel changes

Microaneurysms

• Age 50-80
• 50% hypertension
• 25% have a 5 yr. cardiac mortality
• Photocoagulate if a threat to vision

Neovascularization

• Only in areas of viable tissue
• Diabetes
• BRVO and CRVO
• Sickle ell
• RLF

• Eales disease
• Sarcoid
• Pulseless disease

Parafoveal retinal telangiectasia

• Unilateral
• Males
• May leak and threaten acuity
• Developmental defect

Pulsation’s

• Venous pulsation CRVP
• Increased incidence with age
• Decrease with: lowered IOP, central retinal artery occlusion, increased intra-cranial pressure
• Arterial pulsation
• Glaucoma or internal carotid stenosis

Retinal collateralization

• Capillary enlarges to carry more blood around occlusion

Retinal vessel tortuosity

• Congenital veinous tortuosity
• Most common
• Bilateral and symmetrical
• Acquired veinous tortuosity
• Result of blood sludging as a result of hypoxia
• Carotid artery disease
• Vein occlusions
• Diabetes
• Dyscrasias
• Sickle cell

• Arterial tortuosity
• Rare

Vascular sheathing

• Congenital
  • Common in artery and vein near disc
• Acquired sheathing
  • Arteriosclerosis
    • Increased arterial reflex to silver wire
  • Acquired sheathing of artery and vein
    • Prolonged papillitis
    • Prolonged papillophlebitis
    • Prolonged papilledema
  • Acquired vein sheathing
    • 25% of MS
    • ”Halo sheathing“ following venous occlusion
    • Periphlebitis disease
    • Toxoplasmosis
    • Sarcoid
    • Eales disease

Vitreous hemorrhage

• Diabetes
• Eales disease
• Fragile vessel
• Hypertension
• Retinal tear
• RLF
• Sickle cell
• Trauma
• Periphebletis
• May last for years

[ Home ] [ Eye disease ] [ Vision problems ] [ Examinations ] [ Glasses ] [ Contact lenses ] [ Refractive surgery ] [ Computer vision ] [ Vision & age ] [ Eye safety ] [ Office info ] [ Outreach ] [ What's new? ]

Send mail to don@steensma.net with questions or comments about this web site.
Copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006 Don Steensma, O.D., F.A.A.O.
Last modified: May 1, 2006