Cholesterol embolism is also referred to as atheroembolism or cholesterol-embolization syndrome.
This condition is caused by the sudden breakoff of cholesterol crystals, platelets, or debris from a plaque deposit in an artery. Once dislodged, cholesterol crystals can travel through your bloodstream to any area of your body, including your eyes.
Read on to learn more about cholesterol emboli in your eyes, including symptoms, diagnosis, and treatment.
Emboli is plural for embolus. The Greek word “embolus” translates into plug, or wedge.
Cholesterol emboli are plugs that travel through your bloodstream to smaller blood vessels throughout your body. A cholesterol embolism occurs when a cholesterol embolus completely blocks blood flow in a blood vessel.
When cholesterol emboli break off from plaque deposits, they can travel to and lodge in the tiny blood vessels of your eye, blocking blood flow. This causes inflammation and potential damage, including sudden blindness.
Cholesterol emboli are small, yellowish orange, and shiny in appearance. Emboli usually travel in groups and lodge near each other.
A type of cholesterol emboli in your eye is Hollenhorst plaques. Hollenhorst plaques are a biomarker (sign) of carotid artery disease. They’re usually found at the branches of retinal arteries. Since Hollenhorst plaques are flat in shape, they don’t always block blood flow or require treatment.
The central retinal artery is the final branch of your internal carotid, so plaques of cholesterol in circulation often end up in your central retinal artery.
Cholesterol emboli are caused by the release of cholesterol crystals from atherosclerotic plaques. Having atherosclerosis (narrowing of your arteries) is a major risk factor for cholesterol emboli.
Atherosclerosis is caused by plaque buildup in your artery lining. Procedures designed to diagnose or treat atherosclerosis can release cholesterol emboli as an unwanted side effect. Around
The spontaneous release of cholesterol emboli from your artery can also occur, especially if you have risk factors for this condition.
In addition to atherosclerosis, risk factors for cholesterol emboli include:
If you have cholesterol emboli in an eye, you may be asymptomatic (have no symptoms). Or you may have symptoms that affect your entire body as well as your eye.
Bodily symptoms differentiate this condition from other more common eye health issues, such as macular degeneration or glaucoma, which typically cause eye symptoms only. An exception is narrow-angle glaucoma, which may cause nausea and vomiting.
Systemic symptoms of cholesterol emboli in your eye include:
- weight loss
- muscle pain (myalgia)
Eye symptoms of cholesterol emboli include:
- sudden blindness
- gradual blindness
- temporary loss of vision in one or both eyes (amaurosis fugax)
- retinal (Hollenhorst) plaque that’s visible during an examination
A healthcare professional will take an oral history of your symptoms and current diagnoses. They’ll want to know if you recently had a vascular procedure of any type.
Tests for overall health
Your overall health and vascular health will be assessed:
- Blood tests that check your cholesterol, triglycerides, and glucose (sugar) levels will be administered.
- Certain protein levels in your blood will also be analyzed for signs of inflammation and atherosclerosis.
- You may have a standard blood pressure test and an electrocardiogram.
A carotid duplex ultrasound will be done. This test indicates how well blood is flowing through your carotid arteries. Cholesterol emboli in your eyes often originate in your carotid arteries, which are located in your neck.
Tests for eye health
The presence of cholesterol emboli in your eyes will be assessed with one or more of these procedures:
This is a routine part of any standard eye exam. For this test, a doctor will view your eyes through an ophthalmoscope. This device illuminates your retina, retinal blood vessels, and other eye structures. Your pupils may be dilated first to provide a better internal view.
This may be used to capture a color picture of the back of your eye. The fundus is the part of your eye that includes your retina, optic nerve, and retinal blood vessels. Fundus photography uses a special type of camera. Your pupils will be dilated for this test.
This is another test that generates color pictures of your eye. For this test, fluoroscein, an inert vegetable dye, will be injected into a vein in your arm. Your eyes will be dilated. When the dye passes through your retinal circulation, a special type of camera will take pictures of the internal structures of your eye.
The presence of cholesterol emboli in your eyes doesn’t always indicate the need for treatment. If the emboli aren’t obstructive and don’t inhibit blood flow, no treatment for your eyes may be needed. Watchful waiting and regular eye exams will still be needed to keep an “eye” on the condition though.
Long-term treatments that address the root cause of cholesterol emboli will be important. In some instances, this may include an ongoing regimen of cholesterol-lowering medications such as statins, or blood thinners.
Can statins lower cholesterol in the arteries and eyes?
Statins are lipid-altering drugs that are beneficial for lowering high cholesterol. Statin use may help stave off future occurrences of cholesterol emboli. They may also be beneficial for improving blood circulation in your retinas.
Surgical treatments that address your cardiovascular system may be avoided whenever possible since they’re a catalyst for cholesterol emboli.
Vision loss caused by cholesterol emboli can be challenging to treat. When caught quickly, the reestablishment of retinal blood flow may be restored via laser surgery.
Medications such as vasodilators may be given to dilate the blood vessels in your eye, increasing blood flow.
In some instances, ocular massage may be helpful for dislodging or dissipating cholesterol emboli. This manual procedure may help restore your vision. It’s also done to lower the intraocular eye pressure caused by glaucoma.
Additionally, a painless withdrawal of fluid from the front of your eye (anterior chamber paracentesis) may also be helpful.
Cholesterol emboli are caused by the breakoff of cholesterol fragments from a cholesterol plaque in an artery. These fragmented plaques can travel downstream to small blood vessels in your eye. Cholesterol emboli in your eye may be asymptomatic or lead to devastating visual loss.