This 70YO female was referred for asymptomatic unilateral retinal hemorrhages in her left eye. Vision was 20/30. Optos imaging shows encircling midperipheral deep outer retinal hemorrhages.
Since our patient had a known history of complete left internal carotid artery blockage, no further testing was ordered. We will follow her several times yearly due to the risk of ocular neovascularization.
Learning Points:
The retinal hemorrhages in the ocular ischemic syndrome (OIS) are unique. Retinal vascular disorders like diabetic retinopathy, retinal vein occlusions, and hypertensive retinopathy usually have flame- and dot-shaped inner retinal hemorrhages concentrated around the posterior pole.
Our patient’s findings are classic for OIS, with hemorrhages in the deeper peripheral retina. The retinal periphery is literally the end of the line for the retinal arterial circulation.
In an eye receiving less blood supply due to carotid occlusive disease, the more proximal retina has first dibs on the available oxygen. There are penetrating capillaries that dive radially from the nerve fiber and ganglion cell layers into the deeper retina. The deep vascular complex that supplies the inner and outer plexiform layers is thus furthest downstream, and these endothelial cells are likely damaged in OIS. Blood cells leaking into this space accumulate, causing the large outer blot to hemorrhage.
