Vascular Sheathing

Overview

Vascular sheathing is a term used to describe a white "cuff" around retinal vessels that is caused by the exudation of inflammatory cells. It is typically a sign of active inflammation and vitritis may be associated.

Case Examples

  • Case 1

    A 65 year old African male with pinhole acuities of 6/9.5 (20/32) in each eye. He is being treated for glaucoma but has no other significant ocular history.

    Optomap and green separation images (right eye)

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    Optomap and green separation images (right eye)

    These images show sheathing of the veins of the inferior vascular arcade. The cause of sheathing in this patient was unknown.

  • Case 2

    A 65 year old Middle Eastern male with best corrected visual acuity of 6/7.5 (20/25) in each eye. He has primary open angle glaucoma. He is aware of a problem with the veins in his eyes that was noted 4 years previously. No cause has been determined for the sheathing seen in the clinical images below.

    Fundus photograph and red-free image (right eye)

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    Fundus photograph and red-free image (right eye)

    Significant sheathig of the retinal arterioles can be seen in these images. The cause of the sheathing is again unknown.

    Optomap (1), green separation (2) and fundus autofluorescence (3) images

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    Optomap (1), green separation (2) and fundus autofluorescence (3) images

    The widefield images show the extent of the arteriolar sheathing in this patient. Fundus autofluroescence imaging shows a very slight hyper-reflectivity surrounding the arterioles, consistent with the areas of sheathing.

References

Abu El-Asrar, A. M., Herbort, C. P., & Tabbara, K. F. (2009). Differential diagnosis of retinal vasculitis. Middle East African journal of ophthalmology, 16(4), 202–218.