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Hi everyone, Shalom Aleichem!
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Many people know stroke as a disease that attacks the brain. When most people hear the word stroke, they immediately imagine an asymmetrical face, difficulty speaking, or paralysis on one side of the body. However, not many people know that the eyes can also experience a condition often referred to as stroke mother. Although it does not cause paralysis and death like a brain stroke, an eye stroke is a medical emergency that can lead to permanent vision loss if not treated immediately.
Ironically, the symptoms of an eye stroke are often not accompanied by pain. As a result, many sufferers assume that vision problems are just eye fatigue or a mild problem that will get better by itself. In fact, every minute is precious because retina cells are very sensitive to lack of oxygen supply.
In this thread, I will explain what eye stroke is, what the mechanism is, factors that increase the risk, and steps that can be taken to prevent it.
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What is an Eye Stroke?
Eye stroke is a general term used to describe disruption of blood flow to the retina or important structures at the back of the eye. The retina is a thin tissue whose function is to capture light and convert it into electrical signals which are then transmitted to the brain via the optic nerve. Without an adequate blood supply, retina cells will lack oxygen and nutrients and become damaged.
In contrast to other body tissues, retinal nerve cells have very limited regeneration capabilities. Therefore, the damage that occurs is often permanent.
In general, eye strokes are divided into two main types, namely ischemic eye strokes and hemorrhagic eye strokes.
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Ischemic Eye Stroke
Ischemic eye stroke is the most common type. This condition occurs when the arteries that carry blood to the retina become blocked.
Blockages can be caused by blood clots, buildup of cholesterol plaque, narrowing of blood vessels due to atherosclerosis, or embolus originating from the heart or large blood vessels.
Due to blocked arteries, the retina no longer receives adequate amounts of oxygen. Retinal cells begin to die in just a short time. The longer blood flow is stopped, the larger the area of the retina that is damaged.
In many cases, sufferers experience sudden loss of vision in only one eye. Vision can become blurry, dark areas appear, or even disappear altogether.
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Hemorrhagic Eye Stroke
The second type is hemorrhagic eye stroke, which is a condition when the veins in the retina rupture, causing bleeding.
This bleeding disrupts the function of the retina because the blood that comes out can block the light path to the retina cells and cause tissue swelling.
Several conditions that can trigger retinal hemorrhage include diabetes mellitus, uncontrolled hypertension, retinal blood vessel disorders, eye injuries, and blood clotting disorders.
Even though the mechanism is different from ischemic stroke, the end result is the same, namely retinal damage which has the potential to cause permanent vision loss if not treated immediately.
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Why is the Retina So Vulnerable?
The retina is one of the body tissues that has a very high need for oxygen. The activity of photoreceptor cells continues as long as a person is awake and when the eyes receive light.
Because its energy requirements are so great, the retina depends on a steady blood supply. Even the slightest disturbance in blood flow can reduce cell energy production, so that visual function is immediately disrupted.
If the lack of oxygen lasts too long, retina cells will die. This is the reason why eye stroke is a medical emergency.
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Eye Stroke Symptoms
Eye strokes usually appear suddenly. The most frequently encountered symptoms include:
1) Sudden blurred vision.
2) Loss of vision in one eye.
3) Dark shadows appear in part of the field of view.
4) Appears black spots or empty areas in vision.
5) Decreased visual acuity without pain.
Some sufferers can still see light, but are unable to recognize objects clearly. Because it is painless, many people postpone the examination. In fact, delay in treatment can worsen retinal damage.
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Risk Factors to Be Aware of
Eye strokes do not appear randomly. Most cases are related to blood vessel disease. Factors that increase risk include:
1) Hypertension: High blood pressure can damage the retinal blood vessel walls, increasing the risk of blockage or bleeding.
2) Diabetes mellitus: Long-term high blood sugar levels damage the small blood vessels in the retina and are the main cause of various retinal diseases.
3) High cholesterol: Excess cholesterol accelerates the formation of plaque in the arteries, increasing the possibility of blockages.
4) Smoking: The chemicals in cigarettes accelerate atherosclerosis, increase blood clot formation, and disrupt blood vessel function.
5) Heart disease: Heart rhythm disorders, valve disease, or other heart diseases can produce embolus that block the retinal arteries.
6) Advanced age: The risk increases with age because blood vessels undergo a degenerative process.
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How Do Doctors Make a Diagnosis?
The eye doctor will perform a thorough examination of the retina using an ophthalmoscope or fundus camera. In addition, checks such as:
1) Optical Coherence Tomography(OCT) to see the layers of the retina.
2) Fluorescein angiography to assess retinal blood flow.
3) Blood pressure check.
4) Checking blood sugar levels.
5) Lipid profile examination.
6) Heart examination when the source of embolus is suspected.
A quick diagnosis determines the success of treatment.
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Can Eye Stroke Be Cured?
The answer depends on the cause, the extent of the damage, and how quickly the patient gets help. In ischemic eye stroke, some retinal damage is often permanent because nerve cells cannot regenerate properly. In hemorrhagic eye stroke, the chances of recovery are better if the bleeding can be controlled and the cause treated immediately.
Unfortunately, in many cases, vision loss cannot be completely reversed. Therefore, prevention is much more effective than treatment.
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Eye Stroke Treatment
Therapy is adjusted to the cause. In ischemic eye stroke, the doctor will try to overcome the blockage and control risk factors such as hypertension, diabetes and high cholesterol. In hemorrhagic eye stroke, treatment focuses on stopping bleeding, reducing retinal swelling, and treating the underlying disease.
In some specific conditions, doctors can give anti-VEGF injections into the eye, retinal laser therapy, or surgery when necessary.
The sooner therapy is given, the greater the chance of preserving remaining visual function.
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How to Prevent Eye Stroke
The good news is that most of the risk factors for eye stroke can be controlled through a healthy lifestyle. Some steps that can be taken include:
1) Control blood pressure regularly.
2) Keeping blood sugar levels normal.
3) Manage cholesterol levels.
4) Quit smoking.
5) Exercise regularly according to your ability.
6) Consume balanced nutritious food.
7) Maintaining an ideal body weight.
8) Check your eyes regularly, especially for people with diabetes and hypertension.
9) Comply with the treatment given by the doctor if you have blood vessel or heart disease.
This simple habit not only protects your eyes, but also reduces the risk of brain stroke and heart disease.
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Don’t take sudden blurred vision lightly
Some people wait until the next day when they experience sudden vision problems. This decision could be a big mistake.
Any sudden decrease in vision, especially in just one eye, should be considered an emergency until proven otherwise.
Immediately going to a health facility or ophthalmologist can increase your chances of maintaining visual function.
Remember that the retina is a tissue that is highly dependent on blood supply. When blood flow stops or bleeding occurs, time becomes a very determining factor.
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CLOSURE
Eye strokes do not cause paralysis like brain strokes, but their impact on quality of life is no less great. Permanent vision loss can affect the ability to work, study, drive, read, and carry out daily activities.
The two main types of eye stroke, namely ischemic due to blockage of the retinal artery and hemorrhagic due to rupture of the retinal blood vessels, both require immediate treatment. The sooner a diagnosis is made and therapy is started, the greater the chance of preserving remaining vision.
Therefore, never ignore visual disturbances that appear suddenly. There is only one pair of eyes, and the retina does not have the ability to repair itself like other body tissues. Maintaining healthy blood vessels through a healthy lifestyle is the best investment so that your eyesight is maintained into old age.
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SOURCE
American Academy of Ophthalmology. (2024). Retinal artery occlusion (eye stroke). https://www.aao.org/eye-health/disea…tery-occlusion
Hayreh, S. S. (2011). Ocular vascular occlusive disorders: Natural history of visual outcome. Progress in Retinal and Eye Research, 30(5)359-394.
Merck Manual Professional Edition. (2024). Retinal artery occlusion. https://www.merckmanuals.com/professional
National Eye Institute. (2023). Retinal disorders. https://www.nei.nih.gov
Patel, P. S., & Klufas, M. A. (2023). Central retinal artery occlusion. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470354/
Patel, P. S., & Klufas, M. A. (2023). Retinal vein occlusion. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK525985/
The Royal College of Ophthalmologists. (2022). Retinal vein occlusion (RVO) guidelines. https://www.rcophth.ac.uk
Yau, J. W. Y., Rogers, S. L., Kawasaki, R., et al. (2012). Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care, 35(3)556-564.
