CASE REPORT
Acute Monocular Painless Vision Loss in an Elderly Man By Mani Hashemi, MD
Kendall Regional Medical Center
By Harold Gomez Acevedo, MD
Kendall Regional Medical Center
By Arvin Jandu, MD
Kendall Regional Medical Center
By Moises Moreno, DO
A 79-year-old male with a history of diabetes mellitus, atrial fibrillation, and hyperlipidemia presented to the Emergency Department (ED) with a chief complaint of painless left eye vision loss. His symptoms started the previous night, approximately 20 hours prior to arrival, and were described as a sudden onset of “cloudy and darkening” vision from his left eye, which rapidly progressed to complete vision loss within minutes. Vision from his right eye remained unchanged. He noted that he had a history of uncomplicated cataract surgery to his left eye four months prior, and his family noted that he had stopped taking Xarelto one month ago. The patient otherwise denied other symptoms.
During his initial presentation, his vital signs were within normal limits. On physical examination, he was noted to have an afferent pupillary defect as well as significantly reduced visual acuity in the left eye (20/200). Intraocular pressures were 14 mmHg and 11 mmHg in the left and right eyes, respectively. Ocular point-of-care-ultrasound (POCUS) was performed using a 12 Megahertz (MHz) linear probe (Fig. 1).
DIAGNOSIS:
Central Retinal Artery Occlusion CRAO is classically diagnosed in patients presenting with painless vision loss via fundoscopy,
Kendall Regional Medical Center
REFERENCES
1. Systemic diseases in noninflammatory branch and central retinal artery occlusion--an overview of 416 patients. Schmidt D, Hetzel A, Geibel-Zehender A, Schulte-Mönting. 2007 Dec 14, Eur J Med Res, pp. 12(12):595-603. PMID: 18024271. 2. The retrobulbar "spot sign" as a discriminator between vasculitic and thrombo-embolic affections of the retinal blood supply. Ertl M, Altmann M, Torka E, Helbig H, Bogdahn U, Gamulescu A, Schlachetzki F. ltraschall Med. 2012 Dec;33(7):E263-E267. doi: 10. : Ultraschall Med., 2012 Dec, Vols. 33(7):E263-E267. doi: 10. 3. Vascular risk factors for central retinal artery occlusion. Rudkin AK, Lee AW, Chen CS. London : Eye (Lond)., 2010 Apr, Vols. 24(4):678-81. doi: 10.1038/ eye.2009.142. Epub 2009 Jun 12. PMID: 19521436.
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Fig. 1: Ultrasonography of the left eye obtained with the linear probe in axial-transverse axis with the patient in the supine position, demonstrating a retrobulbar hyperechoic focus (retrobulbar spot sign) at the junction of the optic nerve and the globe, highly suggestive of emboli. EMpulse Spring 2021
