67 y/o male with hypertension, and poor compliance presents complaining of sudden decreased vision in Right eye.
Age and medical background support an underlying vascular event having taken place. A careful fundus exam is required.
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| Treatment is initially directed at determining the underlying cause and correcting it as soon and as best as possible. These patients are frequently started on low dose aspirin to minimize further platelet clotting. As well if ischemia is detected through fluorescein angiography and other methods such as laser treatment is advised. Here a panretinal photocoagulation is performed to destroy as much of the ischemic peripheral retina as possible and therefore reduce the chances of developing a neovascular glaucoma. | Branch retinal vein occlusions also occur and can cause a marked reduction of vision. Here clotting occurs where the vein and artery cross. In this location the vessels share an adventitial coverings. In the presence of longstanding hypertension and/or atherosclerosis the arterial wall thickens gradually compressing the vein. This set up causes turbulence and slowing of blood flow in the adjacent vein and possibly potentiating a clot formation. The hemorrhage and exudate pattern is distributed in the area drained by the obstructed vein. If the edema extends centrally enough a decrease in vision will occur. Many of the BRVOs encountered resolve spontaneously but it is not uncommon to have to resort to laser treatment. Again this is performed to destroy the locally ischemic retina and to reduce the edema affecting the macular area. Inflammation of the retina is becoming a more frequent cause of decreased vision. Over the last decade Cytomegalovirus Retinitis in AIDS and iatrogenically immunocompromised patients has come to the forefront. The inflammation may be quite extensive but the retina has no pain sensitive nerves limiting the symptomatology. Approximately 15-40% of AIDS patients will develop this retinal infection, usually in the late stages of their disease. |