This 71YO patient has bilateral, mostly temporal, peripheral deep blot retinal hemorrhages. He had a known history of bilateral carotid stenosis.
Our patient’s findings are classic for ocular ischemic syndrome (OIS), with hemorrhages in the deeper retina of the temporal periphery.
These patients need to have a carotid Doppler and ultrasound and be referred for medical or surgical intervention for critical stenosis. They may also develop anterior or posterior segment neovascularization requiring photocoagulation and/or anti-VEGF injections. Neovascular glaucoma or hypotony can also occur.
Learning Points:
The retinal hemorrhages in OIS are somewhat unique. Retinal vascular disorders such as diabetic retinopathy, central retinal vein occlusion, and hypertensive retinopathy typically present with flame- and dot-shaped retinal hemorrhages concentrated around the posterior pole, located in the inner 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.
