This patient presented with counting-finger vision and classic findings of a white retina and a cherry-red spot from an acute central retinal artery occlusion (CRAO). The cherry red spot is caused by the unaffected foveal retina (receiving intact choroidal blood flow) being surrounded by more distal white and ischemic retina no longer receiving circulation from the central retinal artery.
On Triton swept-source OCT, the inner two-thirds of the acutely ischemic retina were thickened with marked hyper-reflectivity. Less light reaches the deep retina, making it darker than normal and producing pseudo-edema of the outer nuclear layer.
She was immediately sent to the nearest stroke center, where she was found to have had an acute but asymptomatic lacunar stroke.
Learning Points:
Patients with acute retinal ischemia (acute CRAO, acute branch retinal artery occlusion, or transient monocular vision loss) should be sent immediately to the nearest stroke center due to the risk of a pre-existing or recent asymptomatic stroke or impending stroke (see Biousse et al, Ophthalmology 2018;125;1597-1607).
About 75% of patients with an acute CRAO will be found to have a concurrent, often asymptomatic recent stroke, as was the case with this patient.
