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A 65-year-old man with decreased vision OD
Digital Journal of Ophthalmology 2008
Volume 14, Number 11
June 15, 2008
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Meghomala Das, MRCS | Hairmyres Hospital
Manish Gupta, MRCS | Royal Alexandra Hospital
Robert Harvey, FRCOphth | Royal Alexandra Hospital
Sourjya Kar, MBBS | Huddersfield Royal Infirmary
Differential Diagnosis
OIS should be considered in the differential diagnosis of suspected central retinal vein occlusion (CRVO), diabetic retinopathy and aortic arch disease. In CRVO, there are dilated, tortuous retinal veins, diffuse retinal hemmorhages in all four quadrants including the posterior pole, collateral vessels and edema of the optic disc. Cotton-wool spots can be seen. Retinal artery perfusion remains normal. In OIS, hemorrhages are less numerous, optic disc edema is usually absent and fluorescein angiography (FA) can show retinal capillary nonperfusion.

Diabetic retinopathy is usually bilateral, symmetric and tends to be confined to the posterior pole as opposed to the mid periphery. In addition, hard exudates are also found which are absent in OIS.

Aortic arch disease caused by atherosclerosis, syphilis or Takayasu arteritis produces a clinical picture identical to OIS, and is usually bilateral. Examination reveals absent arm and neck pulses, cold hands, and spasm of the arm muscles with exercise.

OIS can rarely occur secondary to inflammatory vasculitis caused by giant cell arteritis of the ophthalmic artery. As such, in patients over the age of 55, a review of systems addressing jaw claudication, scalp tenderness, and constitutional symptoms should be explored. If there is adequate clinical suspicion, further workup for GCA should be pursued.