Snapshot A 76-year-old man presents to the emergency department with sudden vision loss in his right eye. He described the onset as if a curtain came down over his eye. He has a medical history of hypertension and coronary artery disease. On physical exam a carotid bruit is heard. A funduscopy exam demonstrates whitening of the retina. Overview Occlusion of the retinal artery, leading to occlusion/infarction of the retina can result in permanent or transient vision loss (amaurosis fugax) 2 types central retinal artery occlusion occlusion of the central retinal artery leading to monocular vision loss branch retinal artery occlusion occlusion of the arteriolar branch of the central retinal artery leading to segmental monocular vision loss Epidemiology Incidence more common in the elderly Risk factors carotid artery atherosclerosis carotid Doppler for further evaluation atrial fibrillation arterial hypertension diabetes mellitus hypercholesterolemia carotid artery dissection fibromuscular dysplasia Pathophysiology Cholesterol embolism is the most common cause leads to occlusion of the retinal artery Presentation Symptoms acute and painless monocular vision loss Physical exam retinal whitening (suggestive of ischemia) "cherry-red spot" cherry-red macula surrounded by opacified retina carotid bruit if caused by carotid atherosclerotic disease Studies Fundus fluorescein angiography indication when funduscopic findings for retinal artery occlusion are not present/unclear Serum studies erythocyte sedimentation rate and C-reactive protein > 50 years of age with a central retinal artery occlusion Differential Retinal detachment differentiating factor may appreciate retinal tear or see the detachment Migrain with aura differentiating factor headache is typically present Treatment Currently no known effective therapy Medical ocular massage indication conservative management may theoretically lead to the emboli to move more distally in the artery to reduce retinal ischemia carbogen inhalation or hyperbaric oxygen indication thought to cause vasodilation in an attempt to pass the clot into a distal segment of the occluded vessel Surgical anterior chamber paracentesis indication to decrease intraocular pressure in order to move the emboli more distally in the artery to reduce retinal ishcemia Complications Blindness Prognosis increased risk for cardiovascular and cerebrovascular events Associated condition acute ischemic stroke migraines giant cell arteritis