Ocular ischaemia: signs, symptoms, and clinical considerations for primary eye care practitioners

ABSTRACT

Ischaemic stroke is a major disease burden as well as a leading cause of death. Early signs of ischaemic stroke can manifest in the eye, placing primary eyecare practitioners in an important position to identify patients at risk of ischaemic stroke and initiate suitable referral pathways. The vascular supply to the brain is reviewed with reference to vision including the various retinal signs and ocular symptoms associated with transient ischaemic attacks and ischaemic stroke. Using a range of clinical cases, the diverse clinical presentations of retinal embolic events, as well as other forms of vascular occlusion, are highlighted and the underlying pathophysiology is discussed. A succinct scheme for the assessment and management of ischaemic events for primary eye care practitioners is provided.

KEYWORDS:

• Amaurosis fugax
• anterior ischaemic optic neuropathy
• embolus
• giant cell arteritis
• optical coherence tomography
• retinal ischaemia
• stroke
• systemic hypertension
• transient ischaemic attack
• transient vision loss
• visual field

Acknowledgements

We thank the CFEH clinical team and The Sutherland Hospital Ophthalmology department for providing the cases used in this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

MK, HW, PK and AL received financial salary support through Guide Dogs NSW/ACT. LNS is supported by the National Medical and Health Research Council of Australia National Health and Medical Research Council (NHMRC #1174385). The funders had no role in study design, data collection and analysis, or preparation of the manuscript.