This 94YO female had a prior central retinal artery occlusion (CRAO) with vision that returned back to a baseline of 20/100. There was a history of multiple prior strokes, and she was not a surgical candidate.
Six months later, she came to see us emergently after waking with severe vision loss in her left eye. Vision was light perception.
A fresh CRAO was noted with a stagnant blood column and early inner retinal opacification. Blood flow was immediately restored following paracentesis.
The patient’s daughter reported sadly that the nursing home had made an error and not given her mom anticoagulants for months.
Learning Points:
Measures to relieve the occlusion by moving the causative embolus downstream include vasodilation by increasing the carbon dioxide concentration (rebreathing into a paper bag, carbogen) or rapid IOP lowering (paracentesis, ocular massage). Interestingly, a recent meta-analysis suggested that eyes treated with these measures had worse visual outcomes and recovery rates (Schrag et al, JAMA Neurology 2015;72:1148-1154).
Our patient hasn’t returned yet for us to determine if the paracentesis truly helped.
