Acute obstruction of the central artery of the retina

Blockage of the main trunk of the central retinal artery by an embolus, a thrombus or a sharp spasm of it is clinically accompanied by a sudden blindness of the corresponding eye. Ophthalmoscopic examination reveals turbidity of the mesh shell throughout its entire length, with the exception of the central fossa, and a sharp narrowing of the artery. In the thin arterial branches (vessels of the third order), broken, broken columns of blood are seen. The veins also narrow, but sometimes their usual width remains.

An acute violation of the arterial blood circulation of the retina causes a sharp whitening due to the turbidity and swelling of the interstitial substance. Only the area of the central fossa retains the usual red color, because the mesh shell in this place is very thin and the red color of the choroidi well shines.

The metabolic processes in the nerve cells of the retina are broken and the oxygen deficiency occurs. All this leads to a rapid loss of visual functions. Only in rare cases, when there are arterial vessels that connect the system of the central artery of the retina with the ciliary system of the choroid, the function of the retina in a restricted area where the arterial circulation functions due to the ciliary regulating artery may persist. The embolus clogs the lumen of the main trunk usually in the place of the artery, where it is somewhat narrowed and its walls are tightly fixed (under the latticed plate of the optic nerve). The same picture as with blockage of the artery, is due to endarteritis.

[1], [2], [3], [4], [5], [6], [7]

Symptoms of acute obstruction of the central artery of the retina

The acute obstruction of the central artery of the retina, as a rule, is one-sided. In the clinic, there are also conditions of acute obstruction (embolism, thrombosis, spasm) not only of the main trunk, but also of individual branches of the artery. Then, the clouding of the retina is limited to the area of blood supply of this branch and the fall of the corresponding site in the field of vision. The true embolism of the central artery, as a rule, has a poor prognosis: the functions are not restored.

With sudden blindness, which occurs due to spasm of the central artery of the retina, loss of function is often short-lived. Ophthalmoscopic pictures are similar.

With the above pathology, atrophy of the optic nerve (primarily ascending) occurs. It develops in 2-3 weeks. Occasionally, newly formed vessels appear (a sign of ischemia).

Treatment of acute obstruction of the central artery of the retina

Treatment of acute obstruction of the central artery of the retina is urgent and aimed at:

• spasm elimination - 10% caffeine solution, 0.1% solution of atropine subcutaneously, inhalation amyl nitrate, nitroglycerin, papaverine, no-spa, 1% solution of nicotinic acid intravenously, cardiac glycosides such as strophanthin, digitalis (as antispasmodics lower blood pressure, as a result of which the blood flow slows down and secondary thrombosis may occur), compliance intramuscularly, intravenously (dilates blood vessels and improves heart function), Cavinton intravenously; friskol intravenously, inside;
• influence on internal vessels of a thrombus - urokinase (20-40 thousand ED intravenously), fibrolizin; anticoagulants of direct and indirect action (heparin, phenylin);
• decrease in blood viscosity - trental intravenously (aspirin, papaverine, dimedrol);
• if there is obstruction of blood vessels, angiitis, then corticosteroids are prescribed;
• in the early period - laser coagulation. Against the background of swollen retina, coagulants that penetrate the pigment
• epithelium, form new ways of outflow of edematous fluid into the vascular membrane;
• symptomatic treatment - angioprotectors, biogenic stimulators.