Associated cardiovascular disease

Heart disease is frequently present in patients with embolic CRAO, particularly patients under the age of 40. In a retrospective study 30% of younger and 23% of older patients had cardiac valvular disease as a source of the embolus.8 In a prospective study 56% of patients under age 50 had a potential cardiac source of embolus, compared with 24% in the older age group. Aortic stenosis was the commonest finding and, in the majority, the aortic valve disease was not of haemodynamic significance.25 These data emphasise the importance of a careful cardiac assessment, especially in younger patients, and echocardiography.

CRAO may also be a consequence of disease in situ. Potentiation of atheroma in the ophthalmic or central retinal artery by hypertension may be associated. Patients should be designated hypertensive if the diastolic pressure is 100 mmHg or greater or if they are taking antihypertensive drugs. Most of these patients require a clinical cardiac assessment, an electrocardiogram, and total blood cholesterol (desirable < 200 mg/dl) and low-density lipoprotein (LDL) cholesterol values (desirable < 130 mg/dl).

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