Hello and welcome to Case of the Day! I’m Dr. Croley. Today, we’re going to discuss a patient who came in today with a sudden loss of vision in one eye.
After doing the examination, dilating their eye and checking everything over, what I found was, that they had an emboli or plaque or what we call a Hollenhorst plaque in the artery inside of his eye. The artery that comes out through the nerves, spreads out across your retina, supplying the blood to the retina and then the veins drain the blood back out of the eye and right off where the optic nerve enters the eye, there was a plaque in the artery right where the artery divides into two. As the arteries get bigger, then divide into smaller ones, the plaque could not fit into the next smaller artery, blocking the blood flow. So it was blocking the blood flow to a portion of the retina, unfortunately, involving the central portion of his vision and therefore he had eye can motion vision of two feet, so he’d lost completely almost all his vision in one eye.
What’s worse than circulation and how does this happen? Carotid artery goes up into a side of your brain and supplies the blood to your brain and also a branch that goes off that that then eventually supplies the central retinal artery that supplies the blood to your eye.
People who get emboli or plaques, then we need to find out where did that plaque come from. Very commonly it comes from a plaque in the artery in your neck. As the plaques develop in your arteries, just like there are plaques in your heart and you end up having a heart attack, the plaques in your artery in your neck can break off, and then go into your brain and cause a stroke. In this case, basically a stroke to the retina as the plaque entered the central retinal artery and got inside the eye. Another term for this is amaurosis fugax which is a sudden loss of vision.
We are sending this gentleman to his doctor for health testing. So they’ll do testing of the ultrasounds of the carotid arteries, they’ll do an echo of the heart because if there’s any plaques on the valves of the heart, they could flip off and cause this, we wanna know where these came from. Sometimes you never know so temporarily we put on blood thinners, aspirin and different variety of things until it’s determined where did this come from, if the source can be found. If the source can be found then, of course, that can be treated as appropriate. This is no different than having a stroke where your brain, where you have paralysis. This is a stroke to the eye. The plague that’s called the Hollenhorst plaque.
Unfortunately, when this occurs, very little really can be done to change that. There’s some studies have been done, where if it happens suddenly that you could try to breathe into a paper bag that’s sealed to build up, can maybe dilate the artery a little bit, the plaque can go further down, and you’ll have less loss of vision. You can drain fluid out of the eye, maybe that would let the fluid go through easier.
Massage in the eye has been tried, but this has already been present for a few days, so what damage have done had already been done. They are doing now stroke therapy for having a stroke, they are doing a streptokinase where they actually inject a chemical in your blood to dissolve these clots, but you have to be seen immediately into the emergency room where they can do this. This diminishes the damage done as far as the stroke goes. But unlike in this case, this gentleman had this vision loss for a while so he is not a candidate for any of those kind of things. Unfortunately, he has a permanent loss of his vision. At this point, we need to find out where it came from and if there’s something that’s gonna flip another plaque off and this time go to his brain or somewhere else and cause a stroke then we want to try prevent that.
So if you have any questions about sudden loss of vision or any other questions, we’d be happy to answer those. You can contact us through the website. If not, may God grant you with healthy eyes and great vision.