Retinal artery occlusion

A variety of disorders may lead to rapid, painless, monocular or binocular vision loss. This may include central retinal artery occlusion, acute narrow-angle glaucoma, trauma, or others. The differential diagnosis is complex and needs to be undertaken by an emergency department or ophthalmologist.9... 

Retinal vein occlusion (18-21), retinal artery occlusion (22), and optic neuritis (23,24) have been described in women taking estrogens. 

Wakabayashi Y., Yagihashi T., Kezuka J., Muramatsu D., Usui M., and Iwasaki T. (2006). Glutamate levels in aqueous humor of patients with retinal artery occlusion. Retina 26 432 136. 

Central retinal artery occlusion has previously been reported in cases of intravenous and intranasal cocaine abuse and has also been reported in a man who smoked crack cocaine (166). 

Michaelides M, Larkin G. Cocaine-associated central retinal artery occlusion in a young man. Eye 2002 16(6) 790-2. 

Susac s syndrome is a rare triad of branch retinal artery occlusions, hearing loss and microangiopathy of the brain causing a subacute encephalopathy, almost always in women (Gross and EUashar 2005). 

Factors that mimic glaucomatous visual field loss include branch retinal artery occlusion chorioretinal scars retinal areas treated by photocoagulafion or cryotherapy demyelin-afing disorders cerebrovascular accidents, tumors, or other lesions affecting the optic nerve, chiasm, optic tract, optic radiation, ancPor the remaining course of nerve fibers to the occipital cortex. Other abnormalities that could account for pseudo-glaucomatous visual field defects or vision loss include vitreous hemorrhage, proliferative retinopathy or other retinal disorders. 

Inhibition of plasminogen by tranexamic acid and aminocaproic acid conld theoretically facilitate the development of thrombosis, bnt whether it actnally does so has been the snbject of contradictory reports. Episodes of venous and arterial thrombosis have been reported in association with treatment using either tranexamic acid or aminocaproic acid. These include thrombosis at unusual sites such as mesenteric thrombosis (46), aorta (47), retinal artery occlusion (48), and intracranial arterial thrombosis (49-51), as well as deep vein thrombosis in the legs (52). 

Parsons MR, Merritt DR, Ramsay RC. Retinal artery occlusion associated with tranexamic acid therapy. Am J Ophthalmol 1988 105(6) 688-9. 

Magargal LE, Sanborn GE, Donoso LA, Gonder JR. Branch retinal artery occlusion after excessive use of nasal spray. Ann Ophthalmol 1985 17(8) 500-1. 

Tripathi A, O Donnell NP. Branch retinal artery occlusion another compheation of sUdenafiL Br J Ophthalmol 2000 84(8) 934-5. 

More selective application of thrombolysis has been attempted with injection of urokinase into the ophthalmic artery. Paques et al. (45) reported retrospectively on 26 eyes treated in this method, nine of which were combined central retinal artery occlusion (CRAO) and CRVO. The visual acuity improved significantly in only six... 

Cardiovascular Transient central retinal artery occlusion has been reported after peribulbar anesthesia [30 ]. 

Similar cases of central retinal artery occlusion after peribulbar block have previously been reported [31 ], and it has been... 

Leng T, Moshfeghi DM. Branch retinal artery occlusion after septoplasty. Ophthalmic Surg Lasers Imaging 2010 41 el-2. 

Ascaso FJ. Transient central retinal artery occlusion following peribulbar anesthesia for pars plana vitrectomy. J Clin Anesth 2010 22 577-8. 

Calenda E, Rey N, Compere V, Muraine M. Peribulbar anesthesia leading to central retinal artery occlusion. J Clin Anesth 2009 21 311-2. 

Vinerovsky A, Rath EZ, Rehany U, Rumelt S. Central retinal artery occlusion after peribulbar anesthesia. J Cataract Refract Surg 2004 30 913-5. 

Cardiovascular Three cases of central retinal artery occlusion after surgery with peribulbar anesthesia have been reported [47 ]. In two cases ropivacaine 0.75% (17 and 13 ml) was used in the third case the block was done with 14 ml of 2% mepivacaine. The authors suggested that these cases might be related to raised intraocular pressure due to the block or vasoconstriction caused by the local anesthetics. 

Sensory systems Adverse effects of PDE-5 inhibitors on the eyes have repeatedly been reported, but it is unclear whether these events are coincidental or related to drug-related effects on the ocular circulation or on other structures in the eye [27 ]. In a multicenter study 244 subjects were randomized to tadalafil 5 mg/day, sildenafil 50 mg/day, or placebo for 6 months [28. There was one case of retinal artery occlusion in a patient taking placebo and there were no abnormalities in electroretinogra-phy or visual function and no treatment-related findings suggestive of drug toxicity. 

Both patients had clear anatomical causes for blindness, and unilateral (rather than bilateral) blindness suggested a limited role for systemic arsenic toxicity. Nevertheless, a weak contribution of ocular arsenic toxicity should not be ruled out. Both arsenic trioxide and all-trans retinoic acid can increase intracranial pressure, resulting in pseudotumor cerebri and a secondary increase in intraocular pressure, which may augment retinal injury. Also, arsenic trioxide can cause vasoconstriction and worsen retinal artery occlusion. Finally, elemental arsenic was detected in the eyes at 30-50% of the plasma concentration, a ratio comparable to that in cerebrospinal fluid. This may have direct retinal toxicity, especially with the high peak concentrations associated with intravenous arsenic trioxide. Full ophthalmic evaluation is recommended in patients receiving longterm or intravenous arsenic trioxide. 

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