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Blockage of Central Retinal Vein
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see blockage of central retinal
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- Blockage of the retinal (membrane in the back of the eye) artery (carries oxygen-rich blood to retina) or retinal vein (carries oxygen-poor blood from retina) will lead to painless, Sudden Blindness in
one eye in the case of an arterial (arteries) occlusion, and
more gradual loss of central vision in a venous (veins)
occlusion.
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- Sudden Blindness in
one eye
- Painless
- Center of vision is affected
- Parts other than center of vision
can also be affected
- Stroke
- Glaucoma
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- Emboli -- pieces of clotted blood,
tumor (Atrial Myxoma), plaque (fatty tissue in the
arteries), fat, or vegetation (i.e., bacterial growth) on
the heart valves (endocarditis) can travel through the blood
stream via the arteries, arrive at the narrowed central
retinal artery, and block the flow of the blood to the
retina.
- Blood clot (thrombus) can
also form in the lumen of the retinal artery and, when large
enough, block the flow.
- Temporal Arteritis is
another cause.
- Other forms of vasculitis (e.g.,
lupus erythematosus)
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- History of symptoms, drugs, medications, illness, trauma, family history, Bruising
- Medical exam:
- The test most helpful is an
ophthalmoscopic (a device with a light source that allows
doctor to look inside the eye) examination, in addition to
a general eye examination.
- Using an ophthalmoscope reveals:
- Pupil's abnormal enlargement or
dilation (lack of normal response to light)
- Cherry red spot and ground
glass retina are some of the characteristic findings.
- Retinal arteries are reduced in
size.
- Emboli or blood clots may be seen in the retinal
arteries.
- Tests:
- Blood samples are sent for ESR, platelet count, blood cell count (red and white cells), Fibrinogen levels, antiphospholipid antibodies, PT/PTT, Protein Electrophoresis, glucose, and lipid levels.
- Blood cultures to
rule out infections, such as endocarditis.
- ECG to diagnose heart
arrhythmias.
- Carotid Doppler studies to show
plaques in the carotid arteries, which supply the retinal
arteries.
- Echocardiography will use sound to show bacterial
vegetations or tumors of the
heart.
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- Coagulopathies (e.g., blood flow or clotting problems) such as in Sickle Cell Anemia
- Heart arrhythmias such as atrial
fibrillation
- Intravenous (in the veins) drug
abuse
- Heart tumors
- Oral contraceptives
- Retinal Vein Occlusion -- more
common in elderly
- Atherosclerotic vascular disease
- Hypertension
- Smoking
- High cholesterol
- Diabetes
- Glaucoma
- Male
- Age > 60
- Prolonged pressure on the eye, as in a comatose patient
lying face down
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- An ophthalmologist (eye doctor) may be called in.
Lowering the intraocular pressure to below 15 mm Hg is
helpful and can be done by:
- Applying direct pressure for 5-15
seconds may help to dislodge the emboli, but must be
repeated several times.
- Using a needle to remove some of the fluid inside the
eye (anterior chamber paracentecis)
- Hyperbaric oxygen (chamber where
oxygen given under high pressure), carbogen (using carbon
dioxide gas to dilate the blood vessels), or thrombolysis
using medications to dissolve the clot -- may help if used
within the first 6-12 hours of onset of blindness/symptoms.
- This may be a warning sign for pending Stroke -- a neurologist
should be consulted.
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Contact
911. Get regular eye checkups by a doctor if you have any of
the risk factors.
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