Last additions - Cilioretinal Artery Occlusion - Chronic - Posterior Ciliary Artery Occlusion - Choroidal Ischemia / Infarct 80-year-old woman was seen in the office on 10/26/2010. She notices a cloud in the middle of the vision in the left eye. She says she was looking in the mirror without her glasses on and she noticed things were a little blurred. She covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She did have a history of vision loss in the right eye which was transient and from transient ischemic attacks in 1995. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. She is scheduled for a carotid study in the near future.
VISUAL ACUITY: Vision OD is 20/40, OS is 20/200. IOP: 17 in both eyes.
SLIT LAMP EXAM: The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. There are rare macular drusen.
OS: Vertical C/D ratio is 0.5. There is 1+ pallor of the optic nerve. There is no posterior vitreous separation. There is a prominent cilioretinal artery feeding the inferior half of the macula which is where her visual complaint is. There is no retinal whitening though and there is no evidence of any emboli.
OCT SCAN: The OCT scan of the optic nerve shows nerve fiber layer thinning in each eye with the right eye at 88 and the left eye 91 and there is segmental inferior pallor of the optic nerve.
FLUORESCEIN ANGIOGRAPHY: FA shows poor filling of the cilioretinal artery in the left eye and the choroid in the left eye.
IMPRESSION:
1. CILIORETINAL ARTERY OCCLUSION – LEFT EYE - Possible Ophthalmic Artery Occusion sparing CRA.
2. INFERIOR OPTIC ATROPHY – BOTH EYES
3. HISTORY OF TRANSIENT ISCHEMIC ATTACK – RIGHT EYE
DISCUSSION: I explained to the patient she has had a blockage in one of the main retinal vessels in the left eye which unfortunately has damaged her central vision. At this moment there is no treatment for retinal vascular occlusions, but fortunately the odds are that things will not become any worse. She is already taking a baby aspirin a day. She does need to be evaluated for stroke risks and I will send a letter to her medical doctor to ask him to follow-up with that as well as to check her for possible giant cell arteritis.
The optic nerves do look a little pale and this is suspicious for low-tension glaucoma.
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery725 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery553 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery672 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery506 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery587 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery663 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery735 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery667 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery710 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery623 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery450 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery530 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery644 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery1176 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery815 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery795 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery532 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery567 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery812 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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Cilioretinal artery occlusion and Ophthalmic Artery Occlusion with Relative Sparing of the Central Retinal Artery834 views80-year-old woman who says she was looking in the mirror, covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. OD is 20/40, OS is 20/200.Jan 17, 2012
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80-year-old woman was seen in the office on 10/26/2010. She notices a cloud in the middle of the vision in the left eye. She says she was looking in the mirror without her glasses on and she noticed things were a little blurred. She covered her right eye and noticed she could not see well out of the left eye. That just happened yesterday. Her last eye check was a few years ago. She did have a history of vision loss in the right eye which was transient and from transient ischemic attacks in 1995. She also had a carotid endarterectomy on the right side in 2006 shortly after coronary bypass surgery. She is scheduled for a carotid study in the near future.
VISUAL ACUITY: Vision OD is 20/40, OS is 20/200. IOP: 17 in both eyes.
SLIT LAMP EXAM: The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. There are rare macular drusen.
OS: Vertical C/D ratio is 0.5. There is 1+ pallor of the optic nerve. There is no posterior vitreous separation. There is a prominent cilioretinal artery feeding the inferior half of the macula which is where her visual complaint is. There is no retinal whitening though and there is no evidence of any emboli.
OCT SCAN: The OCT scan of the optic nerve shows nerve fiber layer thinning in each eye with the right eye at 88 and the left eye 91 and there is segmental inferior pallor of the optic nerve.
FLUORESCEIN ANGIOGRAPHY: FA shows poor filling of the cilioretinal artery in the left eye and the choroid in the left eye.
IMPRESSION:
1. CILIORETINAL ARTERY OCCLUSION – LEFT EYE - Possible Ophthalmic Artery Occusion sparing CRA.
2. INFERIOR OPTIC ATROPHY – BOTH EYES
3. HISTORY OF TRANSIENT ISCHEMIC ATTACK – RIGHT EYE
DISCUSSION: I explained to the patient she has had a blockage in one of the main retinal vessels in the left eye which unfortunately has damaged her central vision. At this moment there is no treatment for retinal vascular occlusions, but fortunately the odds are that things will not become any worse. She is already taking a baby aspirin a day. She does need to be evaluated for stroke risks and I will send a letter to her medical doctor to ask him to follow-up with that as well as to check her for possible giant cell arteritis.
The optic nerves do look a little pale and this is suspicious for low-tension glaucoma.
