The four common most types of eye strokes are:
Retinal occlusion and ischemic optic neuropathy can sometimes co-occur.
The termarteriticdescribes reduced blood flow that occurs with inflammation, whilenon-arteriticdescribes reduced blood flow without inflammation.
Eye Stroke Symptoms
Eye stroke usually occurs with little-to-no warning of the impending vision loss.
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There is rarely any pain.
There may also be aloss of peripheral visionor visual contrast, as well as light sensitivity.
The causes and risk factors of eye stroke vary by the condition involved.
RAO and RVO are because of physical obstruction of the retinal artery or retinal vein, respectively.
Veins may be blocked due to compression, usually by a nearby atherosclerotic artery.
The occlusion may last for a few seconds or minutes if the obstruction breaks up.
If it doesn’t self-destruct, the obstruction may be permanent.
Glaucomaalso is a risk factor for retinal occlusion, although it occurs far more frequently with RVO than RAO.
Studies suggest people with glaucoma are five times more likely to develop CRVO than the general population.
AION and NAION are also potential causes of eye stroke.
AION is almost always the result of giant cell arteritis (GCA).
AION
AION is almost exclusively resulting from GCA, also known as temporal arteritis.
When the vessels servicing the optic nerve are affected, AION can result.
GCA is believed to have both genetic and environmental origins.
There are several known triggers for GCA in people who’ve inherited a predisposition to the condition.
Women are up to three times more likely to have GCAand thereby AIONthan men.
NAION
NAION is because of the transient disruption of blood flow to the optic nerve unrelated to inflammation.
Unlike AION, NAION mainly affects the smaller vessels.
The decreased blood flow to the optic nerve typically causes sudden vision loss in one eye.
Another common cause of hypotension and hypovolemia isend-stage kidney disease.
People with end-stage kidney disease are at three times greater risk of NAION than people in the general population.
With that said, having hypotension or hypovolemia does not mean developing NAION is inevitable.
Other risk factors are believed to contribute.
Optic discs normally have an indentation in the center called a cup.
When this occurs, it is not uncommon for NAION to be accompanied by RAO or RVO.
NAION affects 2 to 10 of every 100,000 Americans each year, almost exclusively those over 50.
Whites are affected more than non-Whites.
Eye doctors will also often recruit the help of an internist for further workup.
A neurologist or other subspecialist may become involved as well.
These tests measure systemic inflammation.
To confirm GCA as the cause, the ophthalmologist will order abiopsyof the temporal artery.
A temporal artery biopsy is considered the gold standard for diagnosing of giant-cell arteritis.
The thickening and fragmentation of arterial tissues paired with an infiltration of inflammatory cells are confirmatory of the disease.
NAION occurs without inflammation, so there will be no elevation of the ESR or CRP.
One clue that NAION is involved is the minimal-to-no cupping of the optic nerve.
This can be detected using ophthalmoscopy.
There are no tests to confirm NAION.
Many people with RAO and RVO will regain vision without treatment, although it rarely returns fully to normal.
Once a blockage has occurred, there is no way to physically unblock it or dissolve the embolus.
This condition requires aggressive treatment to prevent total blindness in the affected eye.
Once vision loss occurs, it is almost never fully reversible.
Once prednisone is stopped, methotrexate can continue as a maintenance drug.
Actrema (tocilizumab) is another drug used in “corticosteroid-sparing” therapies.
This may include addressing any underlying risk factors, such as diabetes or high or low blood pressure.
On rare occasion, eye injections may be used.
Anti-VGF monoclonal antibodies have also not proven to be effective in treating NAION.
One approach sometimes considered for people with severe NAION is optic nerve sheath decompression (OPSD).
Prompt treatmentdelivered within hours, not daysis essential to preventing vision loss, particularly if GCA is involved.
Never ignore changes in vision, however minimal.
Frequently Asked Questions
No.
Damage from an eye stroke is limited to your vision.
They have similar risk factors and having one throw in of stroke increases your risk of the other.
An eye stroke can cause partial or total vision loss in the affected eye.
It is not life-threatening.
However, an eye stroke can leave you blind if not treated promptly.
Yes, eye stroke can occur in the weeks following a COVID-19 infection.
COVID-19 is linked to blood clots.
A clot in the arteries of the retina can block blood flow, causing retinal artery occlusion.
Keep up with recommended follow-up appointments with your ophthalmologist and, if recommended, your vision therapist.
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