Cholesterol embolus in the fundus

209 Cholesterol embolus in the fundus



Instruction


Examine this patient’s fundus.



Salient features



History




• Severe, acute and painless diminution or loss of vision


• History of atherosclerosis


• Risk factors of atherosclerosis: family history, diabetes, hypertension, ischaemic heart disease, peripheral vascular disease, cerebrovascular disease.



Examination




• Presence of a cholesterol embolus (Hollenhorst plaques) (Fig. 209.1) in one of the branches of the retinal artery.


image

Fig. 209.1 Cholesterol crystal.


Proceed as follows:



• Look for a cherry-red spot at the fovea (the ischaemic retina at the posterior pole becomes milky white and swollen, and the choroid is seen through the fovea as a cherry-red spot) (Fig. 209.2)


• Tell the examiner that you would like to check for visual field defects.


image

Fig. 209.2 Central retinal artery occlusion.


(With permission from Wong, Mitchell 2007.)


Remember: Retinal artery occlusion results in infarction of the inner two-thirds of the retina, reflex vasconstriction of the retinal arterial tree and stasis in the retinal capillaries.



Diagnosis


This patient has a cholesterol embolus in one of the branches of the retinal artery (lesion) caused by underlying atherosclerotic disease (aetiology).



Questions




What are the complications of such an embolus?


Retinal artery occlusion causing field defects or loss of vision.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Cholesterol embolus in the fundus

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