Hemorrhage In Retina

Cherry red spot on the retina is seen in central retinal artery occlusion. Other retinal signs in this condition includes retinal oedema and segmentation of blood column in the retinal vein (cattle tracking sign). Patients often presents with sudden painless loss of vision.

Reference:
Comprehensive Ophthalmology By A K Khurana, 4th Edition, Page 255.

Central retinal artery occlusion:

• It occurs due to obstruction at the level of lamina cribrosa.
• Causes sudden painless loss of vision.
• Retina becomes white due to oedema & a cherry red spot is seen at the fovea.
• Arterioles become narrow & blood column within the retinal vessels is segmented.
• Resuscitation time of the human retina following retinal ischemia is 11/2 hours.
   

A i.e. Central retinal artery occlusion

All the above can lead to sudden painless loss of vision, but Cherry-Red Spot is seen only in CRAO

Cherry Red Spot

Macula is situated at posterior pole with its centre (foveola) being about 2 disc diameters lateral to temporal margin of disc. When retina becomes milky white due to edema, central part of macular are shows cherry red spot due to vascular choroid shining through the thin retina of this region. Cause are:-

1.        Quinine amblyopia

2.        Niemann-Pick’s diseaseQ

3.        Metachromatic leukodystrophyQ

4.        Multiple sulfatase deficiencyQ

5.        Taysach’s diseaseQ (GM2 gangliosidosis type 1)

6.         Berlin’s oedema / Commotio retinaeQ due to blunt blow on eye

7.        Central Retinal Artery occlusion (CRAO)Q (not in CRVO)Q

8.        Gaucher’s diseaseQ, Goldberg syndrome

9.        Generalized gangliosidosis (Gml gangliosidosis type 1)Q

10.    Sandhoff disease (Gm2 gangliosidosis type 2, sphingolipidosis)

11.    Sialidosis type 1 & 2 (cherry red spot myoclonus syndrome, sphingolipidosis)

12.   Farber’s disease

13.   Hurler’s syndrome (Mucopolysaccharidosis 1H), Hallervorden­Spatz disease

14.   Mucopolysachharidosis VII (3 galactosidase deficiency)

B i.e. Central Retinal Artery Occlusion

Central retinal artery occlusion characteristically presents with sudden painless loss of vision, cherry red spot & cattle-truck appearanceQ (of retinal veins usually).

Source of emboli from carotid artery & heart disease, and thrombus from arteriosclerosis along with hypertension & arteritis are predisposing factors.

C. i.e. Central Retinal artery thrombosis

C i.e. Krabbe’s disease

Krabbe’s disease shows no ophthalmological features.Q

B i.e. Blunt trauma

Blunt trauma to eye may produce Berlin’s edema or commotio retinae Q which manifests as cherry red spot in the foveal region.

C i.e.Trauma

C i.e. Metachromatic leukodystrophy

B i.e. CRVO

Ans. Letterer-Siwe disease

Ans. a and c

Ans. B: Nerve fiber layer

• Located within the NFL
• Flame shape is the result of the structure of the NFL
• Typically located in the posterior pole
• Tend to resolve within a 6 weeks
• Associated with retinal vasculature pathology affecting the superficial and peripapillary capillary beds

Ans. B: CRAO

The cherry red spot is seen in central retinal artery occlusion, appearing several hours after the blockage of the retinal artery occurs.

The cherry red spot is seen because the macula receives its blood supply from the choroid artery while the surrounding retina is pale due to retinal artery infarction.

It is also seen in several other conditions, classically Tay-Sachs Disease, but also in Niemarm-Pick Disease, Sandhoff disease, and mucolipidosis.

Ans. is ‘d i.e., All of the above

Causes of cherry red spot

• GM2 gangliosidoses (Tay sachs & sandhoff)
• Hurler’s syndrome
• GM1 gangliosidoses
• Cryoglobulinemia
• Niemann – Pick’s disease
• Laber’s congenital amaurosis
• Gaucher’s disease   
• Sialidosis (galactosialidosis)
• Metachromatic leukodystrophy
• Mucopolysacharidosis VII
• Central retinal artery occlusion (CRAO)
• Multiple sulfatase deficiency
• Trauma (Berlin’s edema / commotio retinae)
• Poisoning :- Carbon mono-oxide, methanol
• Quinine and Dapsone  
• Shprintzen-Goldberg syndrome
• Farber’s disease 
• Hallervorden Spatz disease
• Goldberg’s disease 
• Rarely in krabbe’s disease

Ans. is `d’ i.e., Multiple aromatase deficiency