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World J Ophthalmol. Nov 12, 2014; 4(4): 124-129
Published online Nov 12, 2014. doi: 10.5318/wjo.v4.i4.124
Retinal emboli
Michelle J Kim, Donald S Fong
Michelle J Kim, Donald S Fong, Kaiser Permanente Southern California Eye Monitoring Center, Baldwin Park, CA 91706, United States
Author contributions: Kim MJ contributed to literature review and manuscript drafting; Fong DS contributed to manuscript review and editing.
Correspondence to: Michelle J Kim, MD, Kaiser Permanente Southern California Eye Monitoring Center, 1011 Baldwin Park Blvd. Baldwin Park, CA 91706, United States. jangmichellekim@gmail.com
Telephone: +1-626-8516105 Fax: +1-626-5646106
Received: June 24, 2014
Revised: September 6, 2014
Accepted: September 23, 2014
Published online: November 12, 2014
Abstract

Retinal emboli are opacities identified in retinal arterioles and are often incidental findings on ophthalmic examination. They are generally composed of cholesterol, platelet-fibrin, or calcium and are thought to arise from carotid arteries, coronary arteries, or cardiac valves. In the general population, the estimated prevalence is 0.2% to 1.3%, and the estimated incidence is 0.9% to 2.9%. The transient nature of retinal emboli likely explains the variations between and within these reported figures. The strongest risk factor for retinal emboli is smoking, which has been reported consistently across many studies. Other likely risk factors include older age, hypertension, male sex, total cholesterol, coronary artery disease, and history of coronary artery bypass grafting. The presence of multiple risk factors, as is common in many patients, confers a higher risk for retinal emboli. Several studies suggest that retinal emboli predict an increase in stroke-related, all-cause, and possibly cardiovascular mortality. Due to these sequelae, patients often undergo further workup, most commonly carotid ultrasonography. However, given the low prevalence of significant carotid disease in patients with retinal emboli, further workup, such as carotid ultrasound, should be reserved for those with risk factors for carotid disease. All patients would benefit from medical optimization and coordinated care with the primary care physician.

Keywords: Retinal emboli, Hollenhorst plaque, Stroke, Carotid disease, Cardiovascular disease

Core tip: Retinal emboli occur in up to 3% of the population and predict an increase in stroke-related, all-cause, and possibly cardiovascular mortality. The strongest risk factor for retinal emboli is smoking, which has been reported consistently across many studies. Other likely risk factors include older age, hypertension, male sex, total cholesterol, coronary artery disease, and history of coronary artery bypass grafting. Because many patients with retinal emboli have multiple co-morbidities, they would benefit from medical optimization and coordinated care with the primary care physician. Further workup, such as carotid ultrasound, should be reserved for those with risk factors for carotid disease.