Vascular disorders that affect the eyes include central retinal artery occlusion, central retinal vein occlusion, ischemic optic neuropathy, amaurosis fugax, and occipital lobe vascular accident. CENTRAL RETINAL ARTERY OCCLUSION Occlusion of the central retinal artery produces sudden blindness in the affected eye. The typical cause in older patients is an atheroma, usually broken off the [...]
Occlusion of the central retinal artery produces sudden blindness in the affected eye. The typical cause in older patients is an atheroma, usually broken off the carotid artery wall. The atheroma occludes the central retinal artery in the deeper portion of the optic nerve head and thus cannot be seen. Within an hour after loss [...]
Retinal vein occlusion is probably the most common vascular accident in the eye. About 10% of patients having a central retinal vein occlusion in one eye will also develop one in the other eye. Even after the occlusion occurs, some vision remains. Ophthalmoscopy reveals distended, tortuous veins with massive hemorrhages and edema throughout the retina. [...]
Regardless of the cause, ischemic optic neuropathy almost always occurs in those > 60 yr. Partial or complete loss of vision occurs suddenly, accompanied by swelling of the optic nerve head and often a hemorrhage or two. A visual field defect may produce a loss of half the visual field with a horizontal demarcation. Ischemic [...]
AMAUROS?S FUGAX(Blackouts) When unilateral, amaurosis fugax suggests either retinal or optic nerve ischemia. The blackout may present as a dimming of vision with a slow recovery beginning after 5 to 10 min. The restoration of clear vision occurs in the reverse order from the onset pattern. Several episodes of blackout may precede an attack of [...]
A vascular lesion of the occipital lobe, usually the result of a posterior cerebral artery infarction, is usually characterized by sudden homonymous hemianopia. Infarction in one or both occipital lobes may result from local atheromatous disease, vascular insufficiency, or emboli in the vertebral-basilar system. Total blindness occurs suddenly, with some vision returning within minutes in [...]
Miscellaneous conditions affecting the elderly include acute double vision, diabetic ophthalmoplegia, intracranial tumor, and myasthenia gravis. ACUTE DOUBLE VISION The third cranial nerve innervates the medial, superior, and inferior rectus muscles, the inferior oblique muscle, and the levator muscle and also carries the parasympathetic nerves ponstricting the pupil and controlling accommodation. A complete third cranial [...]
The third cranial nerve innervates the medial, superior, and inferior rectus muscles, the inferior oblique muscle, and the levator muscle and also carries the parasympathetic nerves ponstricting the pupil and controlling accommodation. A complete third cranial nerve palsy results in ptosis; a divergence of the eye when looking straight ahead; a dilated fixed pupil; and [...]
Severe eye or forehead pain followed by a third cranial nerve palsy that spares the pupil should be considered a manifestation of diabetic neuropathy.
An intracranial space-occupying mass is often accompanied by increased intracranial pressure and severe headache. Ophthalmoscopy may show papilledema. Prompt referral for a neurosurgical diagnostic evaluation is indicated.
