Ocular Ischemic Syndrome (OIS) is a rare, primarily unilateral condition caused by hypoperfusion secondary to ophthalmic and carotid artery blockages.1 An internal carotid artery (ICA) stenosis happens 90% of the time causing perfusion pressure to decrease in the central retinal artery.1 In patients with an ICA stenosis, studies have shown that plasma levels of homocysteine and C-reactive protein are linked to the development of OIS.3 When ICA stenosis occurs, there is an incomplete blood circulation in the circle of Willis and ophthalmic artery blood flow reverses to provide the ipsilateral brain.4 This process is called “steal phenomenon” and if prolonged, it results in ocular ischemia with rubeosis iridis and neovascular glaucoma.4 OIS manifests
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Ocular signs and symptoms occur gradually over a few weeks.1 Vision loss is associated with retinal ischemia or damage to the optic nerve.1 Teichopsia, seeing colored afterimages from viewing bright lights, is another common sign caused by macular ischemia.2 A chronic, dull pain in the affected eye can be present due to neovascular glaucoma.2 Signs in the anterior segment include neovascularization of the iris, increased IOP, neovascular glaucoma, ocular hypotony, and opaque aqueous humor.1 When IOP exceeds the perfusion pressure in the central retinal artery, a macular cherry-red spot characteristic of retinal ischemia is seen.1 The lens of the affected eye is opaque than the normal eye and the pupil is semi-dilated with a sluggish reaction to …show more content…
Treatment for OIS can be ocular and systemic with conservative, laser and surgical options.1 In terms of ocular treatment, surgery is ruled out due to the size of the retinal vessels and optic nerve.1 Retinal ischemia treatment is accomplished by ablation of the periphery to reduce retinal oxygen demand.1 This prevents neovascularization at the irido-corneo angle and secondary glaucoma.1 Panretinal photocoagulation (PRP) is another accepted treatment for retinal ischemia that decreases the production of retinal angiogenic growth factors thus preventing neovascular glaucoma.2 Medical treatment to lower intraocular pressure in early stage of NVG consists of beta-blockers or alpha-2-agonists with carbonic anhydrase inhibitors.1 If this option fails and NVG develops, trabeculectomy should be considered.1 Aqueous shunt implants are recommended if trabeculectomy fails as well.1 Ciliary body ablation, cyclocryotherapy, and laser cyclophotocoagulation have been effective in controlling IOP in NVG.2 Prostaglandin analogues are used to decrease IOP in normal-tension glaucoma and anti-inflammatory drugs are used to prevent synechiae in anterior
Ocular signs and symptoms occur gradually over a few weeks.1 Vision loss is associated with retinal ischemia or damage to the optic nerve.1 Teichopsia, seeing colored afterimages from viewing bright lights, is another common sign caused by macular ischemia.2 A chronic, dull pain in the affected eye can be present due to neovascular glaucoma.2 Signs in the anterior segment include neovascularization of the iris, increased IOP, neovascular glaucoma, ocular hypotony, and opaque aqueous humor.1 When IOP exceeds the perfusion pressure in the central retinal artery, a macular cherry-red spot characteristic of retinal ischemia is seen.1 The lens of the affected eye is opaque than the normal eye and the pupil is semi-dilated with a sluggish reaction to …show more content…
Treatment for OIS can be ocular and systemic with conservative, laser and surgical options.1 In terms of ocular treatment, surgery is ruled out due to the size of the retinal vessels and optic nerve.1 Retinal ischemia treatment is accomplished by ablation of the periphery to reduce retinal oxygen demand.1 This prevents neovascularization at the irido-corneo angle and secondary glaucoma.1 Panretinal photocoagulation (PRP) is another accepted treatment for retinal ischemia that decreases the production of retinal angiogenic growth factors thus preventing neovascular glaucoma.2 Medical treatment to lower intraocular pressure in early stage of NVG consists of beta-blockers or alpha-2-agonists with carbonic anhydrase inhibitors.1 If this option fails and NVG develops, trabeculectomy should be considered.1 Aqueous shunt implants are recommended if trabeculectomy fails as well.1 Ciliary body ablation, cyclocryotherapy, and laser cyclophotocoagulation have been effective in controlling IOP in NVG.2 Prostaglandin analogues are used to decrease IOP in normal-tension glaucoma and anti-inflammatory drugs are used to prevent synechiae in anterior