Window to the circulatory system: Ocular manifestations of cardiovascular diseases

Abstract

The changes in the cardiovascular system are associated with ocular manifestations, often as a consequence of pathological alteration in the ocular vasculature. The ease of visualization of these retinal changes makes the eye a window to the cardiovascular system. Certain congenital cardiac defects lead to changes in the retinal vascularity due to increased tortuosity and dilatation. In adults, the arterial dissection of internal carotid and vertebral arteries present as amaurosis fugax with or without oculo-sympathetic palsy. The patients with untreated infective endocarditis present with Roth spots, retinitis, embolic retinopathy, or sub-retinal abscesses. Hypoperfusive, hypertensive, or “mixed” retinopathy is a hallmark sign in patients of untreated infective endocarditis. Giant cell arteritis can present with ischemic ocular symptoms that may precipitate in irreversible vision loss. Systemic vascular manifestations such as coronary artery disease may manifest in a wide range of symptoms from amaurosis fugax to vision loss depending upon the size and location of retinal emboli. Rare cardio-oncological pathologies such as myxomas result in vision loss secondary to central retinal artery occlusion. A high clinical suspicion in patients with history of cardiovascular diseases can help in early diagnosis and management of impending, adverse cardiovascular and cerebrovascular events. In this review, we comprehensively discuss the spectrum of cardiac and vascular diseases with ocular manifestations as well as highlight the typical ocular presentations associated with these pathologies.

Choroidal Thickness and Granulocyte Colony-Stimulating Factor in Tears Improve the Prediction Model for Coronary Artery Disease

“…This means that factors such as the possible effect of a time-lapse between having passed the acute phase of the disease, or daily uctuations in CT may have had a signi cant in uence on obtaining the data. In any case, it is practically impossible to establish the isolated connection between CAD, CT and clinical risk, as a great number of physiological variations, lifestyle, pharmacological treatment and comorbidities such as high blood pressure, dyslipidaemia, diabetes or other in ammatory and autoimmune conditions have been individually associated with the increase or decrease of clinical risk 1,15 . Given this circumstance, from a clinical perspective, it would be more practical to create and validate prediction models that integrate all of these conditions, as we have undertaken in this work.…”

“…Recently, ophthalmologic ndings have been associated with preclinical neurologic conditions as Alzheimer's disease 13,14 . Moreover, changes in the cardiovascular system have also been related with signs that are visible in the eye, making this organ a window that provides quick access to the cardiovascular system thanks to the ease with which it is possible to see ndings 15 . Finally, considering that some CRF for CVD such as diabetes, high blood pressure or hyperlipidaemia, produce typical, speci c lesions in the eye fundus, there is a clearly established relationship between this organ and cardiovascular conditions.…”

Branch Retinal Artery Occlusion Secondary to Infective Endocarditis

“…Given the patient's history of dizziness and tonsillitis, cardiac valve disease is most likely. Using transthoracic echocardiogram and Streptococcus viridans -positive blood cultures, the patient was diagnosed with infective endocarditis without fever and with loss of visual field as the only symptom [ 5 ].…”

“…In spite of infective endocarditis having many different forms of presentation, a high clinical suspicion is often required to reach the diagnosis. The ophthalmological pathology can help to uncover serious underlying medical conditions, which may reduce mortality and morbidity in these patients [ 5 , 6 ].…”

Ultra-wide-field retinal imaging in tetralogy of Fallot before and after cardiac surgery

“…2 The etiology of these vascular changes has been attributed to hypoxia and secondary erythrocytosis, even though systemic vascular endothelial growth factor (VEGF) levels are found to be elevated in these patients. 3 This article describes retinal vascular changes using ultra-wide-field (UWF) imaging in a case of ToF prior to and after surgical correction of ToF.…”