Table of ContentsView AllTable of ContentsTypesSymptomsCausesDiagnosisEye Stroke TreatmentFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Types
Symptoms
Causes
Diagnosis
Eye Stroke Treatment
Frequently Asked Questions
Symptoms of eye stroke include sudden blurring or vision loss in all or part of one eye, usually without pain. While the sudden loss of vision can be frightening, prompt medical attention can often prevent or limit permanent damage.
This article discusses the different types of eye strokes, including retinal artery occlusion, retinal vein occlusion, arteritic anterior ischemic optic neuropathy, and non-arteritic anterior ischemic optic neuropathy. It also explains the symptoms of different types of eye strokes, various causes, how eye strokes are diagnosed, and treatment options.
Jim Craigmyle / Getty Images
Types of Eye Stroke
The four common most types of eye strokes are:
Retinal occlusion and ischemic optic neuropathy can sometimes co-occur.
The termarteriticdescribes reduced blood flow that occurs with inflammation, whilenon-arteriticdescribes reduced blood flow without inflammation.
Eye Stroke Symptoms
Eye stroke usually occurs with little-to-no warning of the impending vision loss. Most people with eye stroke notice a loss of vision in one eye upon waking in the morning or experience worsening vision over the course of hours or days. There is rarely any pain.
Some people will notice darkened areas (blind spots) in either the upper or lower half of thefield of vision. There may also be aloss of peripheral visionor visual contrast, as well as light sensitivity.
Retinal Vascular Occlusion
Depending on which vessels in the eye are occluded, the symptoms and severity of the resultingvisual disturbancecan vary. The types of retinal occlusion are broadly characterized as follows:
What Are Retinal Migraines?
Ischemic Optic Neuropathy
The symptoms of anterior ischemic optic neuropathy can vary depending on whether the condition is arteritic (AAOIN) or non-arteritic (NAOIN). The symptoms are categorized as follows:
How Ischemia Affects Different Parts of the Body
Eye stroke is caused when the flow of blood to the back of the eye is impaired, starving tissues of oxygen. In the same way a stroke causes cell death in the brain due to the lack of oxygen, an eye stroke can destroy tissues of the retina or optic nerve, thus preventing the transmission of nerve signals to the brain.
The occlusion may last for a few seconds or minutes if the obstruction breaks up. If it doesn’t self-destruct, the obstruction may be permanent.
Both RAO and RVO are closely linked to cardiovascular diseases (involving the heart and blood vessels) and cerebrovascular diseases (involving the blood vessels of the brain). The risk factors for retinal vascular occlusion include:
Retinal occlusion tends to affect people over 50, with men being slightly more at risk than women.Retinal occlusion in younger people often is related to a blood clotting disorder such as thrombophilia.
Glaucomaalso is a risk factor for retinal occlusion, although it occurs far more frequently with RVO than RAO. Studies suggest people with glaucoma are five times more likely to develop CRVO than the general population.
How a Stroke Causes Vision Loss
AION and NAION are also potential causes of eye stroke. AION is almost always the result of giant cell arteritis (GCA). Similarly, with NAOIN, the vascular damage to the optic nerve is related to a multitude of factors that uncommonly come together to cause nerve injury.
AION
Other rare causes of AION arelupus(an autoimmune disorder) and periarteritis nodosa (a rare inflammatory blood vessel disease).
GCA causes inflammation of the medium to large blood vessels which can “spill over” to the smaller vessels, causing them to swell and obstruct blood flow. When the vessels servicing the optic nerve are affected, AION can result.
GCA is believed to have both genetic and environmental origins. There are several known triggers for GCA in people who’ve inherited a predisposition to the condition. One is a severe bacterial or viral infection: Studies suggestvaricella-zoster virus (shingles)may be involved in the onset of GCA in up to 74% of people.
Another is inflammatory disorders (includingautoimmune diseases).For example, GCA is closely linked topolymyalgia rheumatica, which occurs in 40% to 50% of people with GCA.
NAION
One condition believed to increase the risk of NAION isnocturnal hypotension(low blood pressure during sleep) which can reduce the amount of blood that reaches the optic nerve. The decreased blood flow to the optic nerve typically causes sudden vision loss in one eye.
Other known risk factors for NAION include:
Another common cause of hypotension and hypovolemia isend-stage kidney disease. People with end-stage kidney disease are at three times greater risk of NAION than people in the general population.
With that said, having hypotension or hypovolemia does not mean developing NAION is inevitable. Other risk factors are believed to contribute.
NAION affects 2 to 10 of every 100,000 Americans each year, almost exclusively those over 50. Whites are affected more than non-Whites.
Serious Causes of Vision Loss
Based on the results and the characteristics of your vision loss, along with a review of your medical history and risk factors, your eye doctor may perform some or all of the following tests, which are usually effective in diagnosing retinal vascular occlusion:
Other tests may be ordered to identify the underlying cause of eye stroke. Among them,blood pressure readingsand blood tests (includingserum glucose,complete blood count,platelet count, anderythrocyte sedimentation rate) can help identify if diabetes, cardiovascular disease, a clotting disorder, or an inflammatory process is involved.
Eye doctors will also often recruit the help of an internist for further workup. A neurologist or other subspecialist may become involved as well.
How the Field of Vision Is Tested
Diagnosing Ischemic Optic Neuropathy
Because retinal occlusions involve the physical obstruction of a blood vessel, they are often easier—or at least more straightforward—to diagnose than ischemic optic neuropathy.
While ophthalmoscopy and OCT can help detect optic nerve damage, AION or NAION require an extensive investigation with additional tests and procedures.
AION is suspected if the erythrocyte sedimentation rate (ESR) andC-reactive protein (CRP)test are both elevated. These tests measure systemic inflammation.
There will also be characteristic signs of GCA, including jaw spasm, fever, muscle aches, and scalp tenderness.
To confirm GCA as the cause, the ophthalmologist will order abiopsyof the temporal artery. Performed underlocal anesthesiaon an outpatient basis, the biopsy is used to obtain a small sample of tissue from the temporal artery which is situated close to the skin just in front of the ears and continues to the scalp.
A temporal artery biopsy is considered the gold standard for diagnosing of giant-cell arteritis. The thickening and fragmentation of arterial tissues paired with an infiltration of inflammatory cells are confirmatory of the disease.
How Giant Cell Arteritis Is Diagnosed
NAION occurs without inflammation, so there will be no elevation of the ESR or CRP. One clue that NAION is involved is the minimal-to-no cupping of the optic nerve. This can be detected using ophthalmoscopy.
To confirm a NAION diagnosis, your eye doctor will exclude other possible causes in thedifferential diagnosis, including:
NAION is diagnosed clinically based on a review of symptoms, optic nerve characteristics, and predisposing risk factors. There are no tests to confirm NAION.
The Link Between Headaches and Visual Disturbances
The goal of treatment for the various types of eye stroke is to restore vision or at the very least minimize vision loss.
Many people with RAO and RVO will regain vision without treatment, although it rarely returns fully to normal. Once a blockage has occurred, there is no way to physically unblock it or dissolve the embolus.
There is also a treatment called anti-vascular endothelial growth factor (anti-VEGF) that is warranted if you have risk factors for neovascularization in vein occlusions. Anti-VEGF is amonoclonal antibodyinjected into the eye that blocks the growth of new blood vessels that can lead to glaucoma and progressive vision loss.
Eylea and Lucentis are approved to treatmacular degenerationbut are sometimes used off-label to prevent progressive vision loss in people with RVO.
This condition requires aggressive treatment to prevent total blindness in the affected eye. Once vision loss occurs, it is almost never fully reversible. Without treatment, vision loss will occur in the majority of people with AION and eventually affect the other eye in 50% of cases.
The first line of treatment is systemic corticosteroids delivered either orally (in tablet form) or intravenously (injected into a vein). Oral prednisone is taken daily for several weeks or months and thengradually tapered offto prevent withdrawal and other serious side effects.
Some healthcare providers, concerned about the long-term side effects of prednisone use (including the risk of cataracts), may opt to taper the corticosteroid dose while adding theimmunosuppressivedrug methotrexate to the treatment plan.
Actrema (tocilizumab) is another drug used in “corticosteroid-sparing” therapies. It is an injectable monoclonal antibody approved for the treatment of GCA that is typically used when prednisone underperforms or poses a risk of severe side effects.
As with methotrexate, Actrema is given once weekly and introduced to the treatment plan as the prednisone dose is gradually tapered down.
Ways to Reduce Prednisone Side Effects
NAION can be as challenging to treat as it is to diagnose, but if not treated, it causes vision loss or impairment in 45% of people.
To prevent recurrence or the involvement of the other eye, it is important to treat the underlying cause of NAION with help of the patient’s primary care provider. This may include addressing any underlying risk factors, such as diabetes or high or low blood pressure.
On rare occasion, eye injections may be used. Though corticosteroid eye injections have been proposed as a treatment for NAION, they have not proven to be any more effective than oral corticosteroids and may end up injuring the optic nerve. Anti-VGF monoclonal antibodies have also not proven to be effective in treating NAION.
Optic nerve sheath decompression may be useful in people with acute NAION symptoms, potentially stopping the progression of vision loss, but is usually not helpful when damage to the optic nerve has already occurred.
A Word From Verywell
If you experience sudden vision loss of any sort, see your healthcare provider immediately or go to your nearest emergency room. Prompt treatment—delivered within hours, not days—is essential to preventing vision loss, particularly if GCA is involved.
If you notice a vision change that is progressive or unexplained, that is usually enough to warrant a visit to your healthcare provider or an ophthalmologist. Never ignore changes in vision, however minimal.
How to Know When a Vision Problem Is an Emergency
Frequently Asked QuestionsNo. Damage from an eye stroke is limited to your vision. A stroke that affects the brain causes weakness, paralysis, language deficits, feeding difficulties, memory issues, incontinence, and fatigue.Not directly. An eye stroke can increase your risk of a brain stroke, but it will not directly cause a brain stroke. They have similar risk factors and having one type of stroke increases your risk of the other.An eye stroke can cause partial or total vision loss in the affected eye. It is not life-threatening. However, an eye stroke can leave you blind if not treated promptly.Yes, eye stroke can occur in the weeks following a COVID-19 infection. COVID-19 is linked to blood clots. A clot in the arteries of the retina can block blood flow, causing retinal artery occlusion.Keep up with recommended follow-up appointments with your ophthalmologist and, if recommended, your vision therapist. This professional works to help restore lost vision and teach you to ways to cope, such as using vision aids and assistive technologies.
No. Damage from an eye stroke is limited to your vision. A stroke that affects the brain causes weakness, paralysis, language deficits, feeding difficulties, memory issues, incontinence, and fatigue.
Not directly. An eye stroke can increase your risk of a brain stroke, but it will not directly cause a brain stroke. They have similar risk factors and having one type of stroke increases your risk of the other.
An eye stroke can cause partial or total vision loss in the affected eye. It is not life-threatening. However, an eye stroke can leave you blind if not treated promptly.
Yes, eye stroke can occur in the weeks following a COVID-19 infection. COVID-19 is linked to blood clots. A clot in the arteries of the retina can block blood flow, causing retinal artery occlusion.
Keep up with recommended follow-up appointments with your ophthalmologist and, if recommended, your vision therapist. This professional works to help restore lost vision and teach you to ways to cope, such as using vision aids and assistive technologies.
34 Sources
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