A 67-year-old man experienced sudden loss of vision in the left eye 3 hours ago.

You record VA as OD
20/20 and OS no light perception The and OS no light perception. The right pupil responds to light
directly but not consensually the left responds to light consensually, the left responds to light
consensually but not directly. Dilated fundus of the right eye is normal. The left eye shows a white,
opacified retina, a cherry red spot in the macular and sluggish retinal circulation. • What do you think
the patient has and how to treat?

I think the patient has central retinal artery occlusion due to various symptoms. These are;

 Dramatic, unilateral, sudden, painless loss of vision (exception – presence of cilioretinal

arteries).
 Blockage occurs by an embolus/atherosclerosis of CRA at the lamina cribrosa.
 Marked afferent pupillary defect.
 Fundus – Opaque retina, cherry red spot at the macula, segmentation of the blood column in
the veins (Cattle trucking).

Treatment

• OCULAR EMERGENCY: attempt to restore blood flow within 2 h (irreversible retinal damage if >90 min
of complete CRAO)

• massage the globe (compress eye with heel of hand for 10 s, release for 10 s, repeat for 5 min) to
dislodge embolus

• decrease IOP

■ topical β-blocker

■ IV acetazolamide

■ IV mannitol (draws fluid from eye)

■ drain aqueous fluid – anterior chamber paracentesis (carries risk of infection, lens puncture)

• YAG laser embolectomy

• intra-arterial or intravenous thrombolysis

• hyperbaric oxygen therapy