HEAD, EYE, EAR, NOSE, AND THROATEMERGENCIESTREATMENT
■ Goal of therapy is to move the clot into a branch of the retinal artery and
decrease infarct size. Response to treatment is rare.
■ Digital massage of the globe may help dislodge the embolus.
■ Increased inspired CO 2 is recommended to dilate retinal arterioles. Carbo-
gen is recommended for this, but having the patient breathe into a paper
bag can achieve similar effects.
■ Consider acetezolamide or topical blockers to decrease IOP.
■ Ophthalmology consult
Central Retinal Vein Occlusion
ETIOLOGY
■ Atherosclerosis builds up causing occlusion and thrombosis of the central
vein (see Figure 14.44).
■ Risk factors include hypertension and DM.
SYMPTOMS/EXAM
■ Gradual painless monocular vision loss (more gradual than CRAO)
■ Dilated congested veins with a “blood and thunder”appearance of the
retina
■ Numerous retinal hemorrhages = cotton wool spots and macular edema.
■ Optic-disk edema
TREATMENT
■ No acute treatment
■ Consider same Rx for CRAO and aspirin
■ Ophthamology consult
Blood and thunder = CRVO.
Cherry red spot = CRAO.FIGURE 14.43. Central retinal artery occlusion with macular cherry red spot and pallor
between macula and disk.
(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski SJ. Emergency
Medicine: A Comprehensive Study Guide, 6th ed.New York: McGraw-Hill, 2004:1461.)