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Updated: Dec 15 2021

Retinal Artery Occlusion / Amaurosis Fugax

  • Snapshot
    • A 76-year-old man presents to the emergency department with sudden vision loss in his right eye. He described the onset as if a curtain came down over his eye. He has a medical history of hypertension and coronary artery disease. On physical exam a carotid bruit is heard. A funduscopy exam demonstrates whitening of the retina.
  • Overview
    • Occlusion of the retinal artery, leading to occlusion/infarction of the retina
      • can result in permanent or transient vision loss (amaurosis fugax)
      • 2 types
        • central retinal artery occlusion
          • occlusion of the central retinal artery leading to monocular vision loss
        • branch retinal artery occlusion
          • occlusion of the arteriolar branch of the central retinal artery leading to segmental monocular vision loss
  • Epidemiology
    • Incidence
      • more common in the elderly
    • Risk factors
      • carotid artery atherosclerosis
        • carotid Doppler for further evaluation
      • atrial fibrillation
      • arterial hypertension
      • diabetes mellitus
      • hypercholesterolemia
      • carotid artery dissection
      • fibromuscular dysplasia
  • Pathophysiology
    • Cholesterol embolism is the most common cause
      • leads to occlusion of the retinal artery
  • Presentation
    • Symptoms
      • acute and painless monocular vision loss
    • Physical exam
      • retinal whitening (suggestive of ischemia)
      • "cherry-red spot"
        • cherry-red macula surrounded by opacified retina
      • carotid bruit if caused by carotid atherosclerotic disease
  • Studies
    • Fundus fluorescein angiography
      • indication
        • when funduscopic findings for retinal artery occlusion are not present/unclear
    • Serum studies
      • erythocyte sedimentation rate and C-reactive protein
        • > 50 years of age with a central retinal artery occlusion
  • Differential
    • Retinal detachment
      • differentiating factor
        • may appreciate retinal tear or see the detachment
    • Migrain with aura
      • differentiating factor
        • headache is typically present
  • Treatment
    • Currently no known effective therapy
    • Medical
      • ocular massage
        • indication
          • conservative management
            • may theoretically lead to the emboli to move more distally in the artery to reduce retinal ischemia
      • carbogen inhalation or hyperbaric oxygen
        • indication
          • thought to cause vasodilation in an attempt to pass the clot into a distal segment of the occluded vessel
    • Surgical
      • anterior chamber paracentesis
        • indication
          • to decrease intraocular pressure in order to move the emboli more distally in the artery to reduce retinal ishcemia
  • Complications
    • Blindness
  • Prognosis
    • increased risk for cardiovascular and cerebrovascular events
  • Associated condition
    • acute ischemic stroke
    • migraines
    • giant cell arteritis
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