I am a very fit 67-year-old woman who exercises five times a week and has no risk factors besides age. Suddenly, I have a retinal embolism and it’s diagnosed as an “eye stroke.” What are the implications and prognosis?
A retinal embolism is similar to a stroke, and both are caused by similar conditions.
Emboli can be made up of any of a number of materials found in the body, including air, fat, cholesterol, platelet clumps, blood clots, calcium flecks, or a mixture of these. For practical purposes one can forget about air and fat, and consider only the other materials.
An embolus occurs when some solid material in the heart or blood vessels breaks loose from the spot where it formed, and drifts along with the blood flow in the arteries or veins. The damage it causes depends upon the material, and the spot where the material finally comes to rest and plugs up an artery.
Probably the most common emboli are pulmonary emboli, blood clots which form in the veins of the legs or pelvis, and drift through the veins to the heart. They are pumped through the heart into the pulmonary arteries, where they eventually plug up a large or small branch of the arteries, depending on the size of the clot. If small, these may produce no symptoms, and never be discovered except accidentally. If large they can lead to collapse and shock.
Clots can also form in the chambers of the heart, on the heart valves if they are damaged, and in the arteries themselves. Artherosclerosis, which consists of cholesterol plaques that have formed in the arteries, can cause emboli because the surface of the plaques can break down, possibly releasing cholesterol crystals, or flecks of calcium. The eroded surface of the plaque causes blood and platelets to clot on it, and these can also then break off and be swept downstream to block a distant artery.
Since the brain receives about 25 percent of the total blood pumped out by the heart, it is quite common for an embolus to block an artery in the brain, and cause a stroke. The retinal arteries are quite a bit smaller, but emboli to them do occur.
A variety of tests should be done in a case like yours to try to determine the source of the embolus, since it may be something that can be corrected, avoiding any subsequent emboli. At a minimum these tests would consist of an echocardiogram to see if any clots are present in the heart, or if the heart valves are damaged, an EKG to be sure the heart rhythm is normal, and a sonogram of the carotid arteries which go to the brain, and eye, to see if there are any eroded plaques in them. A more invasive test, a transesophageal echocardiogram, done with a probe that you swallow and that is positioned behind the heart, may be done to rule out atherosclerosis in the aorta.
In the meantime, your doctor probably has you on aspirin, or an even more potent drug to prevent clots from forming, and you will probably be continued on one or another such drug permanently. If you do recover any sight in the eye, it will be within the first couple of weeks after the embolus.
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