Retinal Artery Occlusion

Retinal Artery Occlusion

Article
Eye & Vision
Heart & Vascular Health
+1
Contributed byKrish Tangella MD, MBAMay 16, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Branch Retinal Artery Occlusion (BRAO)
  • Central Retinal Artery Occlusion (CRAO)
  • RAO (Retinal Artery Occlusion)

What is Retinal Artery Occlusion? (Definition/Background Information)

  • Retinal Artery Occlusion (RAO) is a condition wherein a blockage occurs in the arteries, which carry blood to the retina
  • The retina is a layer of tissue situated at the back of the eye and helps in sensing light. When the retina is blocked, it will not be able to receive enough blood and oxygen leading to the loss of vision
  • Although Retinal Artery Occlusion affects both genders, men, specifically those older than 60 years of age, are reported to be more susceptible to the condition than women
  • Certain health conditions such as diabetes, heart valve issues, high blood pressure, etc. can make a individual susceptible to this eye condition. Blood clots, inflammation, infections, and the use of certain drugs are some of the known causes for Retinal Artery Occlusion
  • The signs and symptoms of the condition include sudden blurred vision and blood clot in the eye. A healthcare provider might evaluate one’s retinal health to arrive at a diagnosis of the condition
  • The treatment for Retinal Artery Occlusion needs to be provided in a timely manner, in order to retain sight in the affected eye. If the condition is not treated with urgency, Retinal Artery Occlusion can lead to the loss of sight

Who gets Retinal Artery Occlusion? (Age and Sex Distribution)

  • Typically, men in their seventh decade (between the ages of 60-69 years) are affected by Retinal Artery Occlusion
  • Individuals under 30 years of age may also be affected, though it is very rare
  • Both genders are susceptible, although men are more prone to this eye disorder than women
  • RAO is observed worldwide and all racial and ethnic groups may be affected

What are the Risk Factors for Retinal Artery Occlusion? (Predisposing Factors)

The risk factors for the occurrence of Retinal Artery Occlusion include:

  • Carotid artery disease: A condition where the blood vessels in the neck gets blocked
  • Poorly-controlled diabetes: Diabetics have a high risk of RAO
  • Arterial fibrillation: A condition wherein there are abnormalities in the heart rhythm
  • Certain heart valve conditions
  • Hyperlipidemia: Individuals having high lipid levels in blood are at an increased risk
  • High blood pressure
  • Intravenous drug abuse
  • Temporal arteritis: Temporary arterial damage that occurs due to problems in immune response mechanism

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Retinal Artery Occlusion? (Etiology)

The various causes that can be listed for the occurrence of Retinal Artery Occlusions include:

  • Blood clot or embolism: The retinal arteries could be blocked by a blood clot, which obstructs the passage of blood and oxygen. The clots, occurring in other parts of the body, such as the heart and neck, can travel and block the arteries in the eye. For example, in carotid artery disease, clots could form due to cholesterol, fibrinoplatelet, or calcific embolus
  • Inflammatory causative factors:
    • Giant cell arteritis: An inflammation in the blood vessels, especially in the lining of arteries
    • Polyarteritis nodosa: A rare condition that occurs as a result of inflammation of the blood vessels, resulting in damage of the organ system
    • Systemic lupus erythematosus (SLE): An autoimmune disorder which affects multiple systems in the body
    • Wegener’s granulomatosis: A rare and incurable disease caused by the inflammation of the blood vessels
    • Takayasu’s arteritis: A rare disease caused by inflammation in the walls of the arteries
    • Pancreatitis: Inflammation of the pancreas
  • Thrombophilic disorders such as:
    • Antiphospholipid antibody syndrome: An immune system disorder wherein antibodies produced mistakenly attack the normal proteins in blood
    • Protein S/C deficiencies: Lack of protein C and protein S in blood
    • Leukemia or Lymphoma - blood cancer or bone marrow cancer
  • Infectious origin:
    • Toxoplosmosis: A parasitic disease caused by eating contaminated food
    • Mucomycosis: Fungal infection that affects the sinuses, brain, and lungs
    • Syphilis: A contagious disease spread through sexual activity
  • Pharmacological causes:
    • Oral contraceptive pills
    • Cocaine
  • Ophthalmic causes:
    • Increased intraocular pressure
    • Trauma
  • Retinal migraine: Retinal condition accompanied by migraine headache
  • Atherosclerosis: A condition marked by the hardening of arteries, which can affect the eye

What are the Signs and Symptoms of Retinal Artery Occlusion?

The signs and symptoms exhibited by Retinal Artery Occlusion may include:

  • Sudden blurring of vision, which may affect both eyes or part of one eye
  • A blood clot in the eye
  • Pain in the affected eye may occur in some cases

How is Retinal Artery Occlusion Diagnosed?

The various tests conducted to diagnose Retinal Artery Occlusion may include:

  • Complete physical examination and comprehensive medical history
  • General tests that include:
    • Blood pressure
    • Blood tests to check for cholesterol, triglyceride levels, and erythrocyte sedimentation rate (ESR)
  • Tests done to find out the source of the clot:
    • Echocardiogram
    • Electrocardiogram
    • Heart monitor to check the rhythm of the heart
    • Duplex doppler ultrasound of the carotid arteries
  • Specific tests related to the retina such as:
    • A  thorough inspection of the retina after dilating the pupil in the eye
    • Fluorescein angiography: A special eye test that checks the blood flow in the retina and choroid, which are the two layers found at the back of the eye
    • Visual field examination: An eye examination that concentrates on checking the abnormality in the central and peripheral vision, which may have been caused by various other medical conditions
    • Intraocular pressure: To check the fluid pressure inside the eye
    • Visual acuity: Eye test that is performed to check the clearness of vision
    • Pupil reflex response: Reduction in the size of the pupil in response to light
    • Slit lamp examination: This test uses an instrument that gives a 3-dimensional picture of different parts of the eye
    • Refraction: A test to determine an individual’s prescription for eye glasses
    • Retinal photography: This aims to project the photographs of the inner surface of the eye

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Retinal Artery Occlusion?

The following complications could potentially occur in those with Retinal Artery Occlusion:

  • Glaucoma: An eye disorder that is caused by damage to the optic nerve
  • Loss of vision which could be either partial or complete
  • Stroke - the presence of a blood clot in the brain causing a variety of neurological signs and symptoms

How is Retinal Artery Occlusion Treated?

Retinal Artery Occlusion usually requires an emergent medical treatment, since it can result in the loss of vision. The earlier the treatment is provided, the better is the outcome. The following treatment options may be considered for Retinal Artery Occlusion, though their effectiveness is not clearly known:

  • Breathing in carbon dioxide-oxygen mixture to widen the arteries of the retina
  • Eye massaging
  • Use of tissue plasminogen activator ( a commonly used drug to diffuse a blood clot)

When the loss of vision occurs in the whole of the eye, it is very difficult to get back the vision through any treatment. Any treatment should be administered within 2-4 hours of the symptoms, for it to be effective.

How can Retinal Artery Occlusion be Prevented?

The following measures may be taken for preventing certain blood vessel conditions, such as coronary artery disease, in order to reduce the risk for Retinal Artery Occlusion:

  • Low-fat diet is always recommended
  • Exercise
  • Avoid smoking
  • Reducing obesity or overweight condition
  • Use of blood thinners to prevent blockage of the arteries may be recommended
  • Anti-clotting drugs, such as aspirin, may be prescribed by the physician
  • Warfarin or other blood thinners are used for solving certain heart-related conditions

What is the Prognosis of Retinal Artery Occlusion? (Outcomes/Resolutions)

  • The prognosis depends upon early diagnosis and treatment of Retinal Artery Occlusion. In those with early diagnosis and appropriate treatment, the prognosis is much better. In these individuals, any vision loss can also be reversed
  • In individuals with longstanding vision loss due to Retinal Artery Occlusion, the vision loss may be permanent

Additional and Relevant Useful Information for Retinal Artery Occlusion:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/vision-center/

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Krish Tangella MD, MBA picture
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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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