What Is the Central Retinal Artery?

Central retinal artery occlusion is one of the emergencies leading to sudden blindness, caused by arterial spasm, embolism, endarteritis or atherosclerosis. Unless the obstruction is extremely short-lived and unblocked in time, it will be permanent visual impairment. It is more common in the elderly, and is often accompanied by systemic diseases such as hypertension, arteriosclerosis, and diabetes.

Basic Information

English name

Blockade of Retina Central Arteria

Visiting department

Ophthalmology

Multiple groups

Elderly people with systemic diseases such as hypertension, arteriosclerosis, and diabetes

Common locations

Central retinal artery

Common causes

Arterial wall changes and thrombosis, arterial spasm in acute progressive hypertension, renal hypertension, etc., emboli in the blood circulation, etc.

Common symptoms

Sudden loss of vision, no light perception, pale optic discs, retinal arteries as thin as lines, milky white turbid edema at the posterior pole of the retina, cherry red, etc.

Causes of central retinal artery occlusion

1. Arterial wall changes and thrombosis

Most cases of this disease have cardiovascular system diseases such as arteriosclerosis, hypertension, systemic or local inflammatory vascular disease (such as temporal arteritis, thrombotic vasculitis, nodular periarteritis, behcet disease, Eales disease, Uveitis, etc.) can involve the artery, causing the intimal hyperplasia or edema of the artery, narrowing the lumen and roughening the inner wall. Due to the impulse of blood flow, there is often a gap in the stenosis. When the gap has 1/3 of the original lumen, such as thrombosis, vasospasm, insufficient blood perfusion pressure or elevated intraocular pressure, the gap can suddenly close.

Arterial spasm

Arterial spasm of acute progressive hypertension, renal hypertension, etc., and arterial spasm of chronic arterial hypertension based on extensive sclerosis of systemic arterioles can involve the central retinal artery and cause transient blockage of its trunk or branches.

3. Embolism

The disease is rarely caused by emboli in the blood circulation. Occluded by emboli, emboli often come from the heart valve and nearby aorta inner wall detached from the neoplasm. In addition, literature reports also include: air, fat, tumor fragments, cortisone, pus, parasites and eggs. Before entering the optic nerve and eyeball, the central retinal artery is a good place for embolism due to the narrow diameter of the optic nerve sclera and scleral lamina. Smaller emboli can occur in a branch of the artery.

4. Other

Hemorrhage after ball anesthesia, prone position during surgery, and central retinal artery occlusion can also occur after general anesthesia. The reason may be related to the compression of the eyeball and the patient's blood loss or shock.

Clinical manifestations of central retinal artery occlusion

Vision

Sudden loss, with or without light.

Fundus

The optic disc is pale, the edges are blurred, and the atrophy is pale in the later stage; The retinal arteries are as thin as a line, and the thrombus can be segmental or rosary; The posterior pole of the retina is milky white turbid edema; The macula is cherry red; Arterial pulsation appeared; A few weeks after the onset, retinal edema subsided, and the blood vessels were thinner with white sheaths or white lines.

Central Retinal Artery Occlusion Examination

Electrophysiological examination

It is a typical negative phase wave. The b wave is reduced, and the A wave is negative.

Fundus fluorescein angiography

There may be delayed arterial filling, and the phenomenon of "forward" may be seen; the retinal arteriovenous reflux time is prolonged; the central artery is not perfused;

Central retinal artery occlusion diagnosis

1. History of hypertension, atherosclerosis, temporal arteritis, diabetes, etc.

2. Instant loss of vision.

3. Typical fundus performance.

4. Fundus angiography can help confirm the diagnosis.

Central Retinal Artery Occlusion Treatment

Emergency treatment

(1) Vasodilation Race against time to choose a strong and fast vasodilator.

(2) Reduction of intraocular pressure Including anterior chamber puncture, eye massage uses ocular hypotension drugs to dilate blood vessels.

2. Surgical treatment

Vitrectomy and retinal arterial massage can move the emboli distally.

3. Thrombolytic therapy

It is mainly used in the early stages of onset and effective in some patients

4. Promoting blood circulation and stasis, improving microcirculation.

5. Supportive therapy.

6. Treatment of primary disease.