A retinal vessel occlusion is a blockage in a major artery or vein of the retina Retina The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outermost layer is pigmented, whereas the inner nine layers are transparent. Eye: Anatomy. Depending on the location, the occlusion can be classified as central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), central retinal vein occlusion (CRVO), or branch retinal vein occlusion (BRVO). Typically, a retinal vessel occlusion is a thromboembolic event. Risk factors include hypertension Hypertension Hypertension, or high blood pressure, is a common disease that manifests as elevated systemic arterial pressures. Hypertension is most often asymptomatic and is found incidentally as part of a routine physical examination or during triage for an unrelated medical encounter. Hypertension, diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus, and cardiac Cardiac Total Anomalous Pulmonary Venous Return (TAPVR) valvular disease. Central retinal artery occlusion is characterized by sudden, unilateral, painless loss of vision Vision Ophthalmic Exam and/or transient vision Vision Ophthalmic Exam loss ( amaurosis fugax Amaurosis fugax Transient complete or partial monocular blindness due to retinal ischemia. This may be caused by emboli from the carotid artery (usually in association with carotid stenosis) and other locations that enter the central retinal artery. Carotid Artery Stenosis). Treatment options are limited in all cases and usually ineffective. When the macula Macula An oval area in the retina, 3 to 5 mm in diameter, usually located temporal to the posterior pole of the eye and slightly below the level of the optic disk. It is characterized by the presence of a yellow pigment diffusely permeating the inner layers, contains the fovea centralis in its center, and provides the best phototropic visual acuity. It is devoid of retinal blood vessels, except in its periphery, and receives nourishment from the choriocapillaris of the choroid. Eye: Anatomy is involved, prognosis Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Non-Hodgkin Lymphomas is especially poor, leading to permanent vision Vision Ophthalmic Exam loss.
Last updated: 28 Mar, 2022
The carotid artery with the ophthalmic artery Ophthalmic artery Artery originating from the internal carotid artery and distributing to the eye, orbit and adjacent facial structures. Eye: Anatomy and branches. Note the central retinal artery and posterior choroidal arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries: Histology, which enter the eye around the optic nerve Optic nerve The 2nd cranial nerve which conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. The 12 Cranial Nerves: Overview and Functions.
Image by BioDigital, edited by LecturioSuperior view: The internal carotid artery Internal carotid artery Branch of the common carotid artery which supplies the anterior part of the brain, the eye and its appendages, the forehead and nose. Carotid Arterial System: Anatomy branches into the ophthalmic artery Ophthalmic artery Artery originating from the internal carotid artery and distributing to the eye, orbit and adjacent facial structures. Eye: Anatomy, which further divides into the central retinal artery and the posterior ciliary arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries: Histology.
Image by BioDigital, edited by LecturioThe superior ophthalmic vein and the cavernous sinus, into which the central retinal vein drains.
Image by BioDigital, edited by LecturioExact causes are not known, although there is an association with the following conditions:
Image showing a color fundus Fundus The superior portion of the body of the stomach above the level of the cardiac notch. Stomach: Anatomy photograph of the left eye Left Eye Refractive Errors with CRAO; retinal artery attenuation (arrows) and optic disc Optic disc The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. Eye: Anatomy pallor
Image: “ Color fundus photography Color Fundus Photography Macular Degeneration of the left eye Left Eye Refractive Errors” by Division of Cardiology, Department of Internal Medicine, Pohang St. Mary’s Hospital, Pohang, Republic of Korea. License: CC BY 4.0Fundus photograph of the right eye indicating CRAO/CRVO: a “blood and thunder” appearance and “cherry red” spot are both seen in this image (a patient with systemic lupus erythematosus Systemic lupus erythematosus Systemic lupus erythematosus (SLE) is a chronic autoimmune, inflammatory condition that causes immune-complex deposition in organs, resulting in systemic manifestations. Women, particularly those of African American descent, are more commonly affected. Systemic Lupus Erythematosus)
Image: “ Chorea Chorea Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. Huntington Disease and retinal vessel occlusion” by Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences AND Iranian Center of Neurological Research Research Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. Conflict of Interest, Tehran, Iran. License: CC BY 2.0Central retinal artery occlusion
Central retinal vein occlusion
Diagnosis of both conditions is usually clinical but additional investigations may be ordered.
Image of a 15-year-old girl with left intraretinal hemorrhaging (CRVO) (patient has a history of systemic lupus and antiphospholipid antibodies Antiphospholipid antibodies Autoantibodies directed against phospholipids. These antibodies are characteristically found in patients with systemic lupus erythematosus, antiphospholipid syndrome; related autoimmune diseases, some non-autoimmune diseases, and also in healthy individuals. Antiphospholipid Syndrome)
Image: “Finding of eye fundus Fundus The superior portion of the body of the stomach above the level of the cardiac notch. Stomach: Anatomy” by Department of Pediatrics and Child Neurology, Oita University Faculty of Medicine, Hasama, Yufu, Oita 879-5593, Japan. License: CC BY 2.0Left eye showing “cherry red” spot with retinal pallor typical of CRAO (arrow)
Image: “Acute central retinal artery occlusion” by James Paget University Hospital NHS Foundation Trust Trust Confidence in or reliance on a person or thing. Conflict of Interest, Lowestoft Road, Gorleston, Great Yarmouth NR31 6LA, Norfolk, UK. License: CC BY 2.0