Retinal Macroaneurysm

What's going on?

There is an aneurysm of the retinal arteries usually related to systemic hypertension. The aneurysm walls stretch and leak to different degrees. Sometimes the leakage is minimal, but often the amount of retinal oedema and exudation related to the aneurysm results in reduced vision.

Spontaneous haemorrhage is a concern and can result in significant visual loss.

If I examine the patient, what will I find?

If you follow the blood vessels leading away from the optic disc you will see the dilated portion of artery, usually before the third branch of the vessel. Around this area, you may see the yellowish lipid deposit in the surrounding retina.

What if I've diagnosed it?

If vision is reduced, the patient should be referred urgent via letter. If the vision is unaffected, the patient should be referred soon via letter.

What will the hospital do?

These cases are difficult. If the leakage is marked and vision is poor, argon laser may be applied in order to reduce the leakage and try to close off the aneurysm. There is always a risk that the laser treatment itself may cause a haemorrhage, however.

What do I need to do?

Hypertension is the major predisposing factor for this disorder. Blood pressure should be measured and controlled.

What to tell the patient

They have an area of weakness caused by their high blood pressure resulting in a 'blow-out' of one of the retinal arteries. This may leak or rupture, causing reduced vision. Treatment itself may make things worse.

Problems that may arise, and how to deal with them

Sudden profound visual loss may indicate a spontaneous haemorrhage.