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.

Figure 1

Fundus examination in a patient with sudden painless vision loss in the right eye.

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 …

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