Macrovascular Diseases of the Eye: A Review of Ocular Large Vessel Pathology

Macrovascular diseases of the eye comprise a spectrum of ischemic conditions affecting the ophthalmic vessels, central retinal vessels, and ciliary vessels. These entities, including retinal artery occlusion, ocular ischemic syndrome, anterior ischemic optic neuropathy, retinal macroaneurysm, retinal vein occlusion, and carotid-cavernous fistula, exhibit diverse pathophysiologies and clinical presentations. While some cases progress insidiously, others manifest as emergent vision loss. Rapid bedside diagnostics, particularly the fundus exam, are critical for timely identification, as these conditions not only can be vision-threatening but also indicative of life-threatening cardiovascular pathology. Management strategies are broad, including targeted ocular medication such as intravitreal anti-vascular endothelial growth factors, systemic medications such as thrombolytics, and surgical intervention. While treatment varies, long-term outcomes of all macrovascular eye diseases depend on comprehensive control of systemic cardiovascular risk factors.