[Ocular vasospastic syndrome]

Vasospasm can have many different causes and can occur in a variety of diseases as well as in otherwise healthy subjects. We distinguish between primary vasospastic syndrome and secondary vasospasm. The term "vasospastic syndrome" summarizes the symptoms of patients having such a spasm to stimuli like cold or emotional stress. Patients with primary vasospastic syndrome tend to suffer from cold hands, low blood pressure, migraine and silent myocardial ischemia. The ocular vasospastic syndrome is clearly associated, among other manifestations, with glaucomatous optic neuropathy and non arteritic anterior ischemic optic neuropathy. The ocular vasospasm leads to a compromised autoregulation, and therefore sensitizes the eye to intraocular pressure or to a decrease in blood pressure. A variation in ocular perfusion may lead to an increase in free oxygen radicals and in glutamate. This may finally induce apoptosis cascade in retinal ganglion cells. Valuable diagnostic tools are nailfold capillary microscopy and angiography, but probably the best indicator is an increased plasma level of endothelin-1. The role of calcium channel blockers, magnesium, endothelin and glutamate antagonists are discussed.