Ocular ischaemic syndrome

Abstract

Ocular ischaemic syndrome is a rare condition. It often results in blindness and is linked to serious systemic morbidity. Its presentation is usually subtle and it can be misdiagnosed due to its diverse signs and symptoms. A case of ocular ischaemic syndrome is presented and current diagnostic procedures and treatment described. Recognition by the clinician is important because of the severe ocular and potential systemic sequelae. Keywords: carotid artery, ocular ischaemic syndrome, vascular disease Ocular ischaemic syndrome (01s) is an uncommonly reported, serious blinding condition, first described by Knox in 1965.' It is often misdiagnosed because of its diverse and sometimes subtle presentation.' Sturrock and Miller3 estimated the incidence to be 7.5 cases per million persons per year, based on only six cases over a two-year period in a large hospital setting. However, the exact frequency is unknown and previous reports may underestimate the incidence, when o n e considers the various ocular disorders that have similar presentations. CASE REPORTA 71-year-old Caucasian male presented for optometric examination, complaining of sore, dry eyes and a gradual reduction in distance and near acuity. He had no other presenting complaints. His previous eye examination had been two years earlier. He had a history of head trauma 30 years earlier, which is believed to have resulted in static right optic atrophy. He suffered from severe occlusive carotid artery disease ( O W ) with previous endarterectorny of the right internal carotid artery (ICA) two months before the present examination. The left ICA was reported to be completely blocked and inoperable. There was no history of diabetes.Visual acuities were R 6/24 with +1.25/ -0.75~75 and L 6/ 12 with +1.25/0.25~110. There was no improvement with pinhole (NIPH). A +3.00 D near addition enabled N5 print to be read at 33 cm. At optometric examinations two and four years previously, visual acuities were recorded as R 6/15 = (NIPH) and L 6/4.8. Previous automated visual fields demonstrated a dense temporal defect of the right eye (Figure 1). There was also a right relative afferent pupillary defect. Slitlamp examination revealed moderate signs of dry eye with a reduced tear break-up time and inferior and diffuse sodium-fluorescein and Rose Bengal staining. Non-preserved tear supplements were suggested. The ocular media were clear, but trace left iris neovascularisation was noted. Dilated ocular fundus examination revealed a pale and atrophic right optic disc. In the left posterior pole, focal and general arteriole attenuation was noted. Scattered small blot retinal haemorrhages were also noted in all four quadrants (Figure 2). Intraocular pressures (IOP) were R 9 mmHg and L 9 mmHg measured with Perkins

Bilateral acute Ocular Ischemic Syndrome following head and neck radiation

“…2 Ocular ischemic syndrome (OIS) can occur when the stenosis of the carotid artery exceeds 90%. 3 OIS is bilateral in 20% of cases, while only 12% of all OIS cases present acutely. We report a patient treated with radiotherapy for left tonsillar squamous cell carcinoma who developed radiation induced bilateral carotid artery occlusion with acute bilateral total blindness.…”

Severe carotid stenosis presenting as ipsilateral ocular ischaemic syndrome: successful treatment with carotid artery stenting

“…(8,9) The optimal treatment of OIS is still uncertain. (12) Carotid endarterectomy may stabilise or improve vision, usually prior to the development of rubeosis iridis (a sign of greater ocular ischaemia), which reduces the likelihood of visual recovery. (4,5) Although visual results after carotid endarterectomy are modest, most authorities recommend that carotid revascularisation be considered for OIS due to severe carotid stenosis.…”

“…(4,5) Hence, treatment of OIS usually entails a combination of carotid revascularisation, pan-retinal photocoagulation and intravitreal injections of anti-VEGF, although the individual response is variable. (4,5,12) No randomised data is available to determine the importance of each of these therapies. It has been reported that pan-retinal photocoagulation causes regression of rubeosis iridis in only 36% of patients and may not improve vision.…”

Preliminary clinical analysis of neovascular glaucoma secondary to carotid artery disease

“…Hypoperfusion retinopathy is a subtype of ocular ischaemic syndrome. It often results in blindness and is linked to serious systemic morbidity 1 . Carotid artery obstruction or stenosis can lead to insufficient blood supply to the eyes and brain and result in a series of symptoms 1 .…”

“…1 Carotid artery obstruction or stenosis can lead to insufficient blood supply to the eyes and brain and result in a series of symptoms. 1 Symptoms of carotid artery stenosis include ipsilateral transient visual obscuration (amaurosis fugax) from retinal ischaemia, contralateral weakness or numbness of an arm, a leg, the face or a combination of these sites, visual field defects, dysarthria and in the case of dominant (usually left) hemisphere involvement, aphasia. 2 Within the ocular region, it can lead to anterior and posterior segment ischaemia.…”