[Circulatory disorders of the retina and optic nerve]

Amaurosis fugax and retinal artery occlusion are mainly caused by emboli originating from the carotid arteries and the heart. Ischemic ophthalmopathy is the result of severe carotid or ophthalmic artery stenosis. Retinal vein occlusions probably develop if the venous outflow is hampered or if blood viscosity is increased. Optic nerve infarction is now regarded as a localized disease of the small vessels. In all circulatory disorders of the retina and the optic nerve a careful medical and neurologic-angiologic work-up is mandatory. For arterial occlusions of the retina or the optic nerve, no therapy is available so far that has unequivocally proven effective. In retinal vein occlusion it has been definitely shown that photocoagulation can prevent ocular complications. The hemodilution therapy for arterial or venous circulatory disorders is as yet not generally accepted since studies are lacking that fulfill the hard criteria of modern therapeutic trials. New data about the risk of cerebral ischemia and survival of patients with ocular circulatory disorders, as well as a critical analysis of the risk and benefit of vascular surgery, have led to a considerable decrease in surgery and favor the medical prevention of stroke.