History
- Sudden onset
- Painless loss of vision
Relevant physical signs
- Relative afferent pupillary defect
- Fundoscopy
- Usually develop after an hour
- Resolves after 5 – 10 days
- Characterized by
- Pale, oedematous retina
- Cherry red spot at the macula
- Underlying cause
- Pulse – atrial fibrillation
- Carotid artery bruits
- Cardiomegaly – intramural thrombus
- Temporal artery tenderness – temporal arteritis
Causes
- Hypercoagulable states
- Antiphospholipid syndrome
- Nephrotic syndrome
- Factor V Leiden
- Protein C deficiency
- Protein S deficiency
- Hyperhomocysteinaemia
- Underlying malignancy
- Embolic
- Internal carotid artery stenosis
- Mural thrombus – atrial fibrillation or cardiomyopathy
- Inflammatory
- Giant cell arteritis
- Polyarteritis nodosa
- Systemic lupus erythematosus
- Hyperviscosity syndromes
- Polycaethaemia
- Chronic leukaemias
- Waldenstrom’s macroglobulinaemia
- Sickle cell anaemia
Investigations
- Cardiovascular risk factors: HbA1c, lipid monitoring
- Carotid artery Doppler
- Trans-thoracic echocardiogram
- Consider temporal artery biopsy to exclude temporal arteritis
Management
- Ocular emergency
- Conservative: ocular massage to restore blood flow
- Treat underlying cause
- Antiplatelets for secondary prevention
- Anticoagulation for embolic stroke
- Steroids for temporal arteritis
- Consider intra-arterial thrombolytic therapy
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