Central Retinal Vein Occlusion Differential Diagnosis

Differential diagnosis
DM retinopathy Ocular Ischemic Syndrome Anterior Ischemic Optic Neuropathy

Diabetic Retinopathy
Ocular manifestation of Diabetes Melitus 80% affected of those with DM > 10 years Result of microvascular retinal changes
Intramural pericyte death and basement membrane thickening Incompetence of vascular walls

Diabetic Retinopathy
Signs and symptoms:
Hemorrhages (dot blot, flame-shaped, pre-retinal, vitreous) Venous beading, IRMA Cotton wool spots Exudates Macular edema

Ocular Ischemic Syndrome

Constellation of ocular signsandsymptomssecondary to severe chronicarterial hypoperfusionto theeye Onset: 50 80 years old Men affected twice as much as women May present with history of other systemic disease: hypertension, DM, CAD

Ocular Ischemic Syndrome

Signs and symptoms
90% presents with visual loss May have dull, radiating eye pain Fundus exam: dot blot hemorrhages, cotton wool spots, retinal nerve fiber layer hemorrhages, venous beading and venous dilation

Ocular Ischemic Syndrome

Causes:
Most common: ipsilateral/bilateral carotid artery stenosis or occlusion (common carotid) Others:
Takayasus arteritis Giant cell arteritis Severe ophtalmic artery occlusion due to thromboembolism

Anterior Ischemic Optic Neuropathy

Loss of vision due to damage to the optic nerve from insufficient blood supply (infarction of short posterior ciliary arteries supplying the anterior optic nerve) Arteritic: temporal arteritis Non-arteritic: cardiovascular risk factors

Anterior Ischemic Optic Neuropathy

Non-arteritic:
Risk Factors:
crowded disc Cardiovascular: HPN, DM, hypercholesterolemia

Anterior Ischemic Optic Neuropathy

Non-arteritic:
Signs and symptoms:
Onset: 50years and below Sudden visual loss upon waking up Optic disc swelling 15% to 20% involvment of other eye within 5 years (+) RAPD

Anterior Ischemic Optic Neuropathy

Arteritic:
Temporal arteritis/ Giant Cell Arteritis Inflammatory disease of medium sized blood vessel High incidence of affecting the other eye if left untreated Onset: >50 years old

Anterior Ischemic Optic Neuropathy

Arteritic:
Signs and symptoms:
Constitutional signs:
Jaw Claudication Scalp tenderness Weight loss, fatigue, myalgia, loss of appetite

Elevated EST and thrombocytosis (+) RAPD Swollen disc Splinter hemorrhages