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Ophthalmic Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Conditions to be considered include: Central retinal artery occlusion.Central retinal vein occlusion.Vitreous haemorrhage.Retinal detachment.Optic neuritis.
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Central retinal artery occlusion is one of the differential diagnoses of sudden painless loss of vision. With this particular clinical problem, a general examination should be performed as well as taking a good past medical history in order to find a root cause. The commonest cause is a thromboembolic event, hence the need for a brief cardiovascular examination. On examination of the eyes, the afferent pupillary defect will be the first noticeable sign (this is seen as an absence of pupillary constriction when a light is shone into the affected eye, whilst there will be pupillary constriction in the affected eye if light is shone into the non-affected eye). The retina will appear pale due to ischaemia, but a cherry-red spot will be evident at the macula due to blood supply coming from the underlying choroid. If central retinal vein occlusion is due to an inflammatory process, such as temporal arteritis (as in the clinical case described), then high-dose steroids are required as soon as possible, as there is only a 6-hour window in which to save the patient’s sight.
The retina, optic nerve and vitreous humour
Published in Mary E. Shaw, Agnes Lee, Ophthalmic Nursing, 2018
Central retinal artery occlusion is considered an ophthalmic emergency because instituting treatment within 2 hours of occurrence may restore the vision which would otherwise be permanently lost. This condition occurs suddenly, without warning, causing painless loss of vision. It is rare, usually only affecting one eye. It is caused by an embolus or thrombus due to arteriosclerosis, mitral stenosis, carotid insufficiency or temporal arteritis and as a complication of thyroid eye disease.
Diffusion-Weighted Magnetic Resonance Imaging in Acute Retinal Pathology
Published in Neuro-Ophthalmology, 2018
Omar Alsinaidi, Aasef G. Shaikh
A 57-year-old woman with history of hypertension presented with acute painless vision loss from the left eye. She reported intermittent symptoms of flashing lights and blurred vision in her left eye for 2 days prior to presentation. Subsequently, her vision acutely turned grey and then black, when she presented to the emergency room. Examination revealed light perception in the left eye, and arteriolar narrowing with boxcarring and a pale fundus. Table 1 depicts the details of pertinent ophthalmological examination. Remaining neurological examination was unremarkable. The findings were consistent with central retinal artery occlusion. DWI sequence revealed multiple areas of diffusion restriction in the left retina (Figure 1A) suggestive of multiple punctate infarcts. There were no significant vascular stenoses, as confirmed in intracranial and neck magnetic resonance angiograms (MRAs). Echocardiogram revealed a mobile mass measuring 1.28 × 0.88 cm on the posterior mitral annulus. The mass was removed surgically, and pathology showed fibrin and calcification consistent with vegetation. Microorganisms were not found, as the patient was on empiric broad-spectrum intravenous antibiotics.
Hyperbaric oxygen therapy in ophthalmic practice: an expert opinion
Published in Expert Review of Ophthalmology, 2020
Lawrence J. Lin, Tiffany X. Chen, Kenneth J. Wald, Andrea A. Tooley, Richard D. Lisman, Ernest S. Chiu
HBOT may play an important role in the treatment algorithm of ocular conditions either as a primary or adjunct therapy. In the field of ophthalmology, recent evidence supports its usage especially for vascular pathologies, such as CRAO and DR. Increased utilization of HBOT may salvage sight in otherwise refractory cases of CRAO and may be an effective treatment option in DR. However, several challenges can deter its widespread integration into the current standard of practice. First, the current level of evidence supporting HBOT efficacy remains low. Although recent literature has reported positive results, the majority of studies are observational in nature and limited by small sample sizes. Second, there are concerns regarding the potential adverse effects of HBOT. Studies suggest that long-term hyperbaric oxygen exposure may result in the development of myopia and cataracts. Although the number of sessions typically used in the treatment of most ophthalmic conditions is relatively low, there remains a risk of iatrogenic changes in visual acuity. Fortunately, the likelihood of complications is rare as reported by two recent randomized controlled trials [81].Third, there is limited accessibility to hyperbaric facilities and the expenses associated with maintaining and providing HBOT may be prohibitive to some institutions and patients. In the United States, the cost of a 90-minute treatment session is approximately 200 USD to 500 USD [82]. However, treatment is often more affordable than the alternatives for debilitating conditions such as central retinal artery occlusion (i.e. fibrinolytics), and largely justified when considering the potential for increased efficacy as well as the consequences of failed treatment.
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2022
David A. Bellows, Noel C.Y. Chan, John J. Chen, Hui-Chen Cheng, Peter W. MacIntosh, Michael S. Vaphiades, Xiaojun Zhang
Chodnicki KD, Tanke LB, Pulido JS, Hodge DO, Klaas JP, Olsen TW, Bhatti MT, Chen JJ. Stroke risk before and after central retinal artery occlusion: a population-based analysis. Ophthalmology. 2022 Feb;129(2):203–208. doi:10.1016/j.ophtha.2021.07.017