Fig. 21.1
Recent central artery occlusion. Look for the blurring of the retinal vessels, particularly inferiorly, from the swollen retinal axons. Note the cherry-red spot, multiple emboli and stagnation of blood flow in surrounding arterioles.
- Ocular massage – to lower intraocular pressure, increase blood flow and dislodge emboli
- Medications – acetazolamide and/or topical p blockers
- Anterior chamber paracentesis – a needle is passed through the corneal limbus and used to withdraw fluid until the anterior chamber shallows slightly.
Blood tests Urgent erythrocyte sedimentation rate and C-reactive protein levels are measured in patients over 60 years of age, when a diagnosis of GCA cannot be excluded. Coagulation studies, full blood examination and screening tests for vasculitis are usually performed. In the longer term, cardiovascular risk
assessment includes measurement of fasting blood sugar levels and lipid profile.
Ocular investigations Fluorescein delayed arterial filling and masking of background fluorescence by retinal edema.
Surgery Carotid endarterectomy is generally indicated for incomplete stenotic lesions of the carotid artery greater than 70 per cent. Lesser degrees of stenosis are treated non-surgically (i.e. medications and lifestyle adjustments).
Review Initial review is often conducted after an interval of several weeks. Evidence of iris or disc neovascularization is treated with panretinal photocoagulation.
Big Day OR Bad Day
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