Blood supply to the Eye

1
Blood supply to the Eye

• Leo Semes, OD

2
Case Report

• 75 WM
• Reports the following
• . . .at church last week it looked like I was
  seeing through cracked glass.
• What additional information do you want from this
  history?

3
Cracked glass vision in a 75 WM

• Has it happened before / since?
• How long did it last?
• Was it one eye or both? Which one?
• Did you experience any other symptoms?

4
Cracked glass vision in a 75 WM

• What other tests would you do?
• VA
• Anterior segment evaluation
• Tonometry
• Fundus evaluation
• Results All unremarkable for age

5
Cracked glass vision in a 75 WM

• What other tests would you do?
• Carotid auscultation
• Ophthalmodynamometry
• Further carotid testing
• General physical / vascular assessment
• Results

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How would you manage this patient?

• Further testing for carotid assessment
• BP

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Cracked glass vision in a 75 WM

• What could be the cause?
• Local (vitreous traction)
• Vascular
• Retinal vasculature
• Ophthalmic artery
• Carotid artery
• Vertebral basilar
• Other?

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Blood supply to the eye
Branches of internal carotid artery a
internal carotid artery b vertebral artery c
basilar artery d ophthalmic artery e anterior
cerebral artery f middle cerebral artery g
posterior cerebral artery.
9
Blood supply to the eye
10
Cracked glass vision in a 75 WM

• Outcomes
• Carotid Doppler performed
• Demonstrated gt 90 blockage on left side
• Patient recommended for L carotid endarterectomy
• Successfully performed X 2 days
• Patient survived an additional 7 years
  (succumbing to emphysema)