Welcome to Case of the Day!
A patient came in with a sudden loss of vision in one eye. After doing the examination—dilating their eye and checking everything over—it was found that he had emboli (singular embolus) or plaque, or what we call a Hollenhorst plaque, in the blood artery inside of his eye.
The artery that comes out through the nerve spreads out across your retina, supplying the blood to your retina, and then the veins drain the blood back out of the eye. In this patient, right off where the optic nerve enters the eye, there was a plaque in the artery right where it divides into two. As the artery is bigger and divides into those two smaller ones, the plaque cannot fit into the next smaller artery. It was blocking the blood flow to a portion of the retina, unfortunately involving the central portion of his vision. Therefore, he had like “hand motion” vision of up to two feet, so he lost almost all of his vision in one eye.
How does this happen? The carotid artery goes up into the side of your brain, supplies blood to it, and has a branch that then goes off to supply the central retinal artery that supplies the blood to your eye. In people who get emboli or plaques, we need to find out where that plaque came from. Very commonly, it comes from a plaque in the artery in your neck. As the plaques develop in your arteries just like they get in your heart and you end up having a heart attack, the plaques in your artery and your neck can break off and then go into your brain and cause a stroke, or in this case, basically a stroke to the retina as the plaque enters the central retinal artery and got inside the eye. Another term for this is amaurosis fugax, which is a sudden loss of vision.
We sent this gentleman to his doctor to have testing—the ultrasounds of the carotid artery and an echo of the heart, because if there are any plaques on the valves of the heart, they could flip off and cause this, so we want to know where this came from. Sometimes you never know, so temporarily, you put on blood thinners, aspirin, and a variety of things until the source is determined, if the source can be found. If the source can be found, that would be treated as appropriate. This is no different than having a stroke, where you have paralysis. This is a stroke of the eye, and the plaque is called a Hollenhorst plaque.
Unfortunately, when this occurs, very little can be done to change it. There are some studies that have been done, where if it happens suddenly, you could try to breathe into a paper bag; that CO2 buildup can maybe dilate the artery a little bit, and the plaque could go further down, and you’d have less loss of vision. You can drain fluid out of the eye; maybe that would let the fluid go through the blood or go through more easily.
Massaging the eye has been tried, but in this case, this had already been present for a few days; what damage had been done had already been done. They are now doing stroke therapy, as far as having a stroke where they’re doing a streptokinase, where they actually inject a chemical in your blood to dissolve these clots, but you have to be seen immediately in the emergency room, where they can do this. This diminishes the damage done as far as the stroke goes, but like in this case, this gentleman had had this vision loss for a while, so he’s not a candidate for any of those things. Unfortunately, he has a permanent loss of his vision, and we just at this point need to find out where it came from, and if there’s something that’s going to flip another plaque off and this time go to his brain or somewhere else and cause a stroke, then we want to try to prevent that.
If you have any questions about sudden loss of vision, you can always contact us through the website. If not, may God grant you healthy eyes and great vision.
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