Sudden vision loss in a 68-year-old man: the life-saving value of funduscopy

Clinical introduction A 68-year-old man awoke with severe vision loss in the right eye. Three days later, he sought medical attention in the ED. Vision was no light perception in the right eye and 6/6 in the left eye with right brisk relative afferent pupillary defect. Fundus examination is shown in figure 1. Inflammatory markers were ordered and were normal. Question What is the diagnosis? Haemorrhage related to age-related macular degeneration Central retinal artery occlusion Retinal detachment Proliferative diabetic retinopathy Answer:B (B) Central retinal artery occlusion (CRAO). While the centre of the macula, the fovea, has a bright red appearance, this is not a haemorrhage (answers A and D). Ischaemic retina becomes oedematous and white in colour mainly due to swelling of retinal ganglion cell axons located in the inner retina. The fovea does not have retinal ganglion...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research