Vasospasm, its role in the pathogenesis of diseases with particular reference to the eye

Vasospasm can have many different causes and can occur in a variety of dise ases, including infectious, autoimmune, and ophthalmic diseases, as well as in otherwise healthy subjects. We distinguish between the primary vasospas tic syndrome and secondary vasospasm. The term "vasospastic syndrome" summa rizes the symptoms of patients having such a diathesis as responding with s pasm to stimuli like cold or emotional stress. Secondary vasospasm can occu r in a number of autoimmune diseases, such as multiple sclerosis, lupus ery thematosus, antiphospholipid syndrome, rheumatoid polyarthritis, giant cell arteritis, Behcet's disease, Buerger's disease and preeclampsia, and also in infectious diseases such as AIDS. Other potential causes for vasospasm a re hemorrhages, homocysteinemia, head injury, acute intermittent porphyria, sickle cell disease, anorexia nervosa, Susac syndrome, mitochondriopathies , tumors, colitis ulcerosa, Crohn's disease, arteriosclerosis and drugs. Pa tients with primary vasospastic syndrome tend to suffer from cold hands, lo w blood pressure. and even migraine and silent myocardial ischemia. Valuabl e diagnostic tools for vasospastic diathesis are nailfold capillary microsc opy and angiography, but probably the best indicator is an increased plasma level of endothelin-1. The eye is frequently involved in the vasospastic s yndrome, and ocular manifestations of vasospasm include alteration of conju nctival vessels, corneal edema, retinal arterial and venous occlusions, cho roidal ischemia, amaurosis fugax, AION, and glaucoma. Since the clinical im pact of vascular dysregulation has only really been appreciated in the last few years, there has been little research in the according therapeutic fie ld. The role of calcium channel blockers, magnesium, endothelin and glutama te antagonists, and gene therapy are discussed. (C) 2001 Elsevier Science L td. All rights reserved.