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Central retinal artery occlusion


Central retinal artery occlusion disease is one of the most sudden and dramatic events seen in ophthalmology. It also remains a disease of poor visual prognosis despite a multitude of studies and experimental trials. It is the equivalent of a myocardial infarction (heart attack) occurring in the eye. {{more}}

The most common association is arteriosclerosis followed by arterial hypertension (high blood pressure), cardiovascular disorders, Diabetes Mellitus and glaucoma.

The central retinal artery supplies about two-thirds of the circulation and nutrition of the retina so that any obstruction of the same or any of its branches is capable of occasionally producing irreversible damage of our vision.

The onset of obstruction is most often between midnight and 6 a.m., and second most often from 6 a.m. to noon. Presentation is usually with a sudden painless loss of vision; vision at presentation is usually counting fingers to light perception and often remains this way regardless of treatment.

In our physical examination we can find: narrowing and irregularities of the arterioles and venules, the retina, is usually white with a cherry red spot in the fovea (arrow-most central part of the macula which is the small portion in the middle of the retina) and edema in the optic nerve’s head. Visual field defects are usually profound.

Treatment: Results of treatment remain unsatisfactory. The goal is to restore blood flow as soon as possible in all cases seen within 48 hours. This includes the following:

• supine position (face up) – helps maintain circulaocular massage – intermittently for at least 15 minutes to increase blood flow, decrease intraocular pressure (IOP) and possibly dislodge emboli (blood clot or small piece of fatty tissue)

• decrease intraocular with local and systemic medications (Timolol and Diamox)

• use of medications and alternatives to destroy the emboli and improve blood circulation (aspirin)

• The most serious complication of this disease is neovascularization and the development of neovascular glaucoma with very bad prognosis.

Based on the above, we reiterate the importance of having a balanced diet, the control of chronic diseases (hypertension and diabetes) and regular exercise to maintain good health.

Dr Pedro A. Ferrer Suarez Consultant Ophthalmologist (MCMH) Member of the National Cataract Surgery Team of Cuba