Ocular Ischemic Syndrome, Case Study Example

Introduction

Mr. M.R arrived at an eye clinic complaining of dull pain radiating over the eye and eye brow for several days. It was accompanied impaired vision. He is 56 years old and gave a history of type 11 diabetes for over 10 years. An eyedilation examination revealed a retinal hemorrhages and dilated beaded retinal veins and varying degrees. There was decreased ocular perfusion pressure. Upon examining the corneal layers evidence of striae were obvious along with mild anterior uveitis. A cherry-red spot in the macula was identified. Cotton-wool spots were seen in several compartments. This was as aconsequenceretinal eye nerve fiber layer bleeding. Also, the retinal arteries were spontaneously pulsating (Terelak-Borys, Skonieczna & Grabska-Liberek, 2012).

“AH” moment

A differential diagnosis of diabetic retinopathy and central retinal vein occlusion was made. However, the ‘AH’ moment for me came when the optical Coherence Tomography tests showed no retinal thickening. Besides, realizing that there was no abnormal new blood vessels formation (neovascularisation) at the back of the eye significant of proliferative diabetic retinopathy (PDR) I was invigorated confirming that this was not the diagnosis. Next this patient had gone blind unlike presentations of diabetic retinopathy and central retinal veinocclusion when patients complain of blurred vision and hemorrhage is more localized in one region of the eye. It was significantly a defining moment for me (Terelak-Borys et.al, 2012)

Brief pathogenesis/epidemiology

Ocular ischemic syndrome does not frequently occur in humans. Scientific studies reveal that is is caused due to ocular hypoperfusion secondary to internal carotid arteriesstenosis or occlusion. Major changes appear as carotid arteries atherosclerosis. Manifestations are sudden loss of vision; visual field alternations; orbital pain accompanied by numerous posterior and anterior unique adaptations. When anterior segment changes occur they are identified as secondary neovascualar glaucoma; iris neovascularization, iridocyclitis, asymmetric cataract, iris atrophy and reaction to light becoming sluggish (Peter,  David & Danda,  2011).

Essentially, Ocular ischemic syndrome (OIS) is disease of the elderly population. Researchers have quoted a mean of 65 years old. Further, it has been discovered rarely among people below the age 50 age group. Importantly, scientific studies show where the condition is twice less predominant among women than men. There are far greater incidences among person diagnosed with cardiovascular disease as a prevailing underlying morbidity, particularly among the male population. No race predominance has been detected by epidemiologists (Tang, Luo & Peng, 2010).

However, it has been discovered that 20% of all cases there is bilateral cases interference of blood vessels structure and integrity even though exact figures of these incidences are not available for public scrutiny. An estimated at 7.5 cases per million people per year seem to be affected. It must, however, be understood that becauseOcular ischemic syndrome(OIS) can be easily misdiagnosedthese figures could be grossly underestimated (Tang et.al, 2010).

Treatment

Since ocular ischemic syndrome (OIS)is not an isolated ophthalmic disease recommendations are that patients diagnosed with this condition be treated by a team of specialists after other systemic tests have been conducted. The team ought to include vascular surgeons; neurologists; primary care physicians and cardiologists. Intervention encompass systemic therapies laser, surgery which could all be considered a conservative management approach (Butler, 2010).

Conclusion

The foregoing journal case study account is my experience as an advance practice nurse in a clinical setting interacting with a patient and family members. Further the brief analysis of pathogenesis, epidemiology and treatment links the classroom exposure with  the case study interaction.

References

Butler, F. (2010). Hyperbaric oxygen for central retinal artery occlusion.Wound Care & Hyperbaric Medicine 1 (3): 25.

Peter, J. David, S., & Danda, D. (2011). Ocular manifestations of Takayasu arteritis: a cross-sectional study. Retina. 31(6):1170–78

Tang, Y. Luo, D., & Peng, W. (2010) Ocular ischemic syndrome secondary to carotid artery occlusion as a late complication of radiotherapy of nasopharyngeal carcinoma. JNeuroophthalmol,30(4):315–20.

Terelak-Borys, B. Skonieczna, K., &Grabska-Liberek, I. (2012).Ocular ischemic syndrome – a systematic review. International  Medical Journal of Experimental and Science Research; 18(8); 138-144.