Cholesterol embolus in the fundus

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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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

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