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RETINAL VASCULAR DISEASES

Results 1-8 of 11
   
Cotton-Wool Spots  
 

A cotton-wool spot is a white lesion in the superficial retina that usually occupies an area less than a quarter...

A cotton-wool spot is a white lesion in the superficial retina that usually occupies an area less than a quarter of that of the optic disc.

These lesions correspond to focal areas of retinal capillary nonperfusion, resulting in ischemic interruption of the axonal transport in the retinal nerve fiber layer.

Abnormalities Associated with Cotton-Woll Spots in the Fundus:

  • Acquired immunodeficiency syndrome
  • Acute blood loss
  • Acute pancreatitis
  • Aortic arch syndrome
  • Cardiac valvular disease
  • Carotid artery atherosclerosis
  • Central and branch retinal vein obstruction
  • Collagen vascular disease
  • Diabetic retinopathy
  • Dysproteinemias
  • Intravenous drug abuse
  • Leptospirosis
  • Leukemia
  • Metastatic carcinoma
  • Onchocerciasis
  • Papilledema
  • Papillitis
  • Partial central retinal artery obstruction
  • Radiation retinopathy
  • Rocky Mountain spotted fever high-altitude retinopathy
  • Septicemia
  • Severe anemia
  • Systemic arterial hypertension
  • Systemic interferon-alfa administration
  • Trauma
Hypertensive Retinopathy  
 

Hypertensive retinopathy is characterized by retinal vascular derangement caused by severe hypertension. High blood pressure causes both focal and generalized...

Hypertensive retinopathy is characterized by retinal vascular derangement caused by severe hypertension. High blood pressure causes both focal and generalized constriction of the retinal arterioles due to autoregulation.

Chronic elevation of arterial blood pressure and degenerative changes in the arteriolar wall manifest ophthalmoscopically as: retinal arterial attenuation, changes in the arteriolar reflex and arteriovenous crossing changes. Increased vascular permeability can lead to retinal lipid deposits (hard exudates) and flame-shaped hemorrhages. The hemodynamic changes in arterial hypertension can lead to vascular occlusion, focal ischemia and nerve fiber layer infarctions (cotton-wool spots).

Acute severe elevation of blood pressure can give rise to hypertensive choroidopathy. Areas of choroidal infarction can occur, appearing as hyperpigmented lesions surrounded by a halo of hyperpigmentation - Elschnig's spots. Choroidal infarctions can also assume a linear hiperpigmented configuration along a given meridian - Siegrist’s streaks.

Malignant hypertension is associated with disc swelling and retinal hemorrhages around the disc.

Cilioretinal Artery Occlusion  
 

Cilioretinal arteries arise from the short posterior ciliary arteries. They are present in about 30% of normal eyes and can...

Cilioretinal arteries arise from the short posterior ciliary arteries. They are present in about 30% of normal eyes and can contribute to the vascularization of the macula. In a fluorescein angiogram, a cilioretinal artery is perfused before the central retinal artery.

Cilioretinal arteries may become occluded independently, in association with central retinal vein occlusion, or in the context anterior ischemic optic neuropathy.

Carotid artery atherosclerotic disease is frequently associated with cilioretinal artery occlusion.

Branch Central Retinal Artery Occlusion  
 

A branch retinal artery occlusion (one of the branches of the central retinal artery) provokes focal retinal ischemia.

Ischemia of...

A branch retinal artery occlusion (one of the branches of the central retinal artery) provokes focal retinal ischemia.

Ischemia of the inner layers leads to intracellular edema that has the ophthalmoscopic appearance of grayish whitening of the retina along the length of the affected artery.

The site of the obstruction is usually the bifurcation of temporal retinal arteries.

Retinal whitening resolves over several weeks and visual acuity can improve.

Differential Diagnosis

  • Branch retinal vein occlusion
  • Commotio retinae
  • CRAO with cilioretinal artery sparing
Branch Retinal Vein Occlusion  
 

Branch retinal vein occlusion is characterized by dilation and tortuosity of the affected vein associated with retinal hemorrhages, cotton-wool spots,...

Branch retinal vein occlusion is characterized by dilation and tortuosity of the affected vein associated with retinal hemorrhages, cotton-wool spots, and edema in the area drained by the vein.

It is usually caused by a thrombus at arteriovenous crossings where a thickened artery compresses the underlying venous wall.

The complications of branch vein occlusion that are most common and potentially vision-limiting include macular edema and retinal neovascularization.

Differential Diagnosis

  • Diabetic retinopathy
  • Hypertensive retinopathy
  • Leukemic retinopathy
  • Ocular ischemic syndrome
  • Papilledema
  • Retinopathy of anemia
  • Venous stasis retinopathy
Central Retinal Artery Occlusion  
 

Acute central retinal artery occlusion causes sudden painless visual loss occurring over several

seconds.

In the acute stage, the retina...

Acute central retinal artery occlusion causes sudden painless visual loss occurring over several

seconds.

In the acute stage, the retina in the posterior pole loses its transparency and acquires a whitish

appearance. A cherry red spot is present in the region of the foveola.

The pathophysiologic process responsible for a central retinal artery obstruction can include

The following:

  • Circulatory collapse
  • Dissecting aneurysm
  • Emboli
  • Hemorrhage under an atherosclerotic plaque
  • Hypertensive arterial necrosis
  • Intraluminal thrombosis
  • Spasm
  • Vasculitis

Associated systemic abnormalities can be found in approximately 90% of affected patients:

  • Cardiac valvular disease
  • Carotid atherosclerosis
  • Diabetes mellitus
  • Systemic arterial hypertension
Central Retinal Vein Occlusion  
 

Central retinal vein occlusion (CVO) is characterized by diffuse retinal hemorrhages in all quadrants of the retina, and dilated and...

Central retinal vein occlusion (CVO) is characterized by diffuse retinal hemorrhages in all quadrants of the retina, and dilated and tortuous retinal veins.

The clinical appearance may vary from a few scattered retinal hemorrhages with a few cotton-wool spots to very extensive retinal hemorrhages occurring throughout the fundus.

The two major complications associated with CVO are persistent macular edema, and neovascular glaucoma secondary to iris neovascularization.

Neovascular Glaucoma  
 

Neovascular glaucoma (NVG) is a secondary glaucoma that can result in complete loss of vision. Early diagnosis is essential, as...

Neovascular glaucoma (NVG) is a secondary glaucoma that can result in complete loss of vision. Early diagnosis is essential, as are the treatment of intraocular pressure and the underlying cause of the disease. It is often caused by proliferative diabetic retinopathy, central retinal vein occlusion, carotid occlusive disease, and anterior uveitis.

Numerous diseases lead to retinal ischemia and the subsequent release of vascular endothelial growth factor (VEGF) which diffuses to the anterior segment, causing new blood vessels to grow, originally at the pupil margin and then extending over the iris toward the angle. This leads to the formation of fibrovascular membranes that obstruct the trabecular meshwork, causing secondary glaucoma.

The early stage of NVG is characterized by elevated intraocular pressure, proliferation of fibrovascular tissue over the angle, and neovascularization of iris continuous with neovascularization of the angle. The advanced stage shows elevated IOP ( ≥ 60mmHg), reduced visual acuity, retinal neovascularization and/or hemorrhage.

The treatment for NVG is performed with pan-retinal photocoagulation although surgery may be required to lower the intraocular pressure.