**3.2.5 Prognosis**

174 Venous Thrombosis – Principles and Practice

Fig. 13. Clinical photograph of all nine positions of gaze in a patient with a right pupil involving cranial nerve III palsy with right ptosis and exotropia on primary gaze.

Those with cranial neuropathy present with acute binocular diplopia.

cotton-wool spots, optic disc and macular oedema or neovascularisation.

changes, as it is important to investigate the possibility of CNS ischaemia.

anti-thrombin levels, activated protein C resistance and factor V Leiden mutation.

**3.2.3 Investigations** 

**3.2.4 Treatment** 

thrombotic risk.

replacement therapy and smoking.

platelet agents (Ruiz-Irastorza, Hunt et al. 2007).

Patients with retinal vaso-occlusion usually present with pain, unilateral or bilateral decreased visual acuity, visual field defect or amaurosis fugax. Bilateral amaurosis fugax is a very serious condition, and may indicate the presence of central nervous system ischaemia.

On examination, patients with APS may have dry eyes, conjunctival telangiectasia (Miserocchi, Baltatzis et al. 2001) and corneal infiltrates or keratitis. Ocular fundus examination may reveal tortuous and dilated retinal veins, intra-retinal haemorrhages,

Ocular imaging with fluorescein angiography directly visualizes the retinal vessels and occlusion. An MRI scan may be important if there is visual loss without ocular fundus

In addition to imaging, a full thrombophilia work-up may be necessary in the absence of traditional thrombophilia risk factors. This would include searching for antiphospholipid antibodies, including lupus anticoagulant, anticardiolipin antibody and anti-β2 glycoprotein-I antibody. Other screening tests should include homocysteine, protein C and S, plasminogen,

Early detection of ocular manifestations of APS is important as it allows treatment and prevention of further systemic disease. This first involves determining the patient's

The treatment of the systemic disease is vital as it may reverse the retinal ischaemia (Srinivasan, Fern et al. 2001). This should include reducing modifiable risk factors such as hypertension, hyperlipidaemia, diabetes mellitus, oral contraceptive use, hormone

Treatment should also target the cause of the thrombosis. APS with venous thrombosis requires anticoagulation with warfarin while APS with arterial thrombosis requires antiOcular prognosis depends upon the presence of complications such as neovascularisation and therefore, regular ocular monitoring is required.

In patients with antiphospholipid syndrome, the risk of further thromboembolic complications ranges from 22% to 29% (Ruiz-Irastorza, Hunt et al. 2007)
