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Ocular ischemic syndrome
Last reviewed: 23.04.2024
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Ocular ischemic syndrome is attributed to rare conditions resulting from secondary hypoperfusion of the eyeball in response to acute ipsilateral atherosclerotic stenosis of the carotid arteries. Usually occurs in people after 60 years of age and can be associated with diabetes, arterial hypertension, coronary heart disease and cerebrovascular diseases. In 40% of cases, death occurs within 5 years, the cause of which are heart diseases. In patients with ocular ischemic syndrome, an amaurosis fugax may be present in the anamnesis due to retinal embolism.
[Symptoms of ocular ischemic syndrome
In 80% of cases, ocular ischemic syndrome is a one-way process and affects both the anterior and posterior segments. The symptoms are different and may not be expressed, leading to omission or misdiagnosis.
Ocular ischemic syndrome usually manifests itself as a gradual decrease in vision for several weeks or months, sometimes a sudden loss of vision is possible.
What's bothering you?
Diagnostic criteria of ocular ischemic syndrome
Front segment
- Diffuse episcleral injection.
- Edema and striae of the cornea.
- Fleur is watery, sometimes an insignificant cellular reaction (ischemic pseudo-irit).
- The pupil is of medium width, the reaction is sluggish.
- Atrophy of the iris.
- Usually ruby iris with transition to neovascular glaucoma.
- Cataract develops in later stages.
Ocular fundus
- Vein widening with possible tortuosity and narrowing of arterioles.
- Microaneurysms, spot and spotted hemorrhages, less often vat-like foci.
- Proliferative retinopathy with neovascularization in the area of the disk and less often outside of it.
- Edema of the macula.
- For most cases, a spontaneous pulsation of the artery is more pronounced near the disc, which can also be caused by a slight pressure on the eyeball (finger ophthalmodinamometry).
Foveal angiography: delay and non-uniform filling of the choroid, prolongation of the time of the arteriovenous phase, absence of perfusion of the retinal capillaries, late sweating and considerable staining of the arteries.
Tactics
- Changes in the anterior chamber are stopped by local steroids and mydriatica.
- Neovascular glaucoma requires conservative or surgical intervention.
- > Proliferative retinopathy requires a panrectinal laser coagulation, despite less satisfactory results compared with proliferative diabetic nephropathy.
What do need to examine?
Differential diagnosis of ocular ischemic syndrome
Non-ischemic occlusion of the central vein of the retina
- Similarities: unilateral hemorrhages in the retina, widening of veins and cotton-like foci.
- Differences: normal perfusion of the retinal arteries, more hemorrhages, mainly in the form of "flame tongues", there is edema of the optic nerve disc.
Diabetic retinopathy
- Similarities: spot and spotted hemorrhages and retina, yen crimp and proliferative retinopathy.
- Differences: usually bilateral, there are solid exudates.
Hypertensive retinopathy
- Similarities: thinning of arterioles and local constriction, hemorrhages and cotton-like foci.
- Differences: always two-sided, no changes in yen.