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November 5, 2015: Arterial Retinal Ischemic Disease

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Brought to you by the Residents & Fellows Section of Neurology.

November 5, 2015

Arterial Retinal Ischemic Disease

Occlusions of the ophthalmic artery, central retinal artery, or branch retinal arteries can all cause ischemic retinal disease, manifested as acute-onset of painless monocular vision loss. Ophthalmic artery occlusions result in severe visual loss often associated with retinal and optic disc edema in the absence of a cherry red spot on exam, whereas central retinal artery occlusions tend to spare the choroid leaving an underlying area of normally vascularized choroid which appears as a cherry red spot. Branch retinal artery occlusions only produce ischemia in part of the retina, thus sparing parts of the visual field on exam.

These phenomena are frequently due to thromboembolic disease from the anterior cerebral circulation; therefore, management is similar to that of ischemic stroke with brain MRI, head and neck MR angiography, echocardiogram, and, in appropriate patients, hypercoagulable investigation. It is paramount that retinal ischemia be distinguished from optic neuropathy due to giant cell arteritis.

  1. Biousse V, Newman N. Retinal and Optic Nerve Ischemia. Continuum (Minneap Minn) 2014; 20: 838-856.
  2. Newman N, Biousse V. Diagnostic Approach to Vision Loss. Continuum (Minneap Minn) 2014; 20: 785-815.

Submitted by Sarah Wesley, MD, Department of Neurology, Mount Sinai Beth Israel Medical Center.

Disclosures: Dr. Wesley is a member of the Resident and Fellow Section of Neurology.

For more clinical pearls and other articles of interest to neurology trainees, visit Neurology. Listen to this week's Neurology Podcast.

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