Central Retinal Artery Occlusion presents with acute, painless, monocular vision loss and risk factors such as hypertension, atrial fibrillation, and atherosclerosis. Which condition is described?

Central Retinal Artery Occlusion presents with acute, painless, monocular vision loss and risk factors such as hypertension, atrial fibrillation, and atherosclerosis. Which condition is described?

• A. Optic neuritis
• B. Central retinal vein occlusion
• C. Central retinal artery occlusion
• D. Acute angle-closure glaucoma

Answer: (C)

This describes an abrupt, painless loss of vision in one eye due to ischemia of the inner retina from an occlusion of the central retinal artery, a situation driven by embolic or thrombotic events related to widespread vascular disease such as hypertension, atrial fibrillation, or atherosclerosis. The central retinal artery supplies the inner retina, and when it is blocked, the retina becomes pale with the fovea often appearing as a cherry-red spot on exam, reflecting the normal choroidal circulation beneath the fovea. This presentation is different from optic neuritis, which typically causes pain with eye movement and often occurs in younger patients with a demyelinating tendency. Central retinal vein occlusion also causes painless vision loss but the fundoscopic finding is a swollen, congested retina with widespread retinal hemorrhages (“blood and thunder”), not a pale retina with a cherry-red spot. Acute angle-closure glaucoma presents with a red, painful eye, rapidly elevated intraocular pressure, mid-dilated fixed pupil, and halos around lights—features not described here. Thus, the described scenario aligns with central retinal artery occlusion.

This describes an abrupt, painless loss of vision in one eye due to ischemia of the inner retina from an occlusion of the central retinal artery, a situation driven by embolic or thrombotic events related to widespread vascular disease such as hypertension, atrial fibrillation, or atherosclerosis. The central retinal artery supplies the inner retina, and when it is blocked, the retina becomes pale with the fovea often appearing as a cherry-red spot on exam, reflecting the normal choroidal circulation beneath the fovea.

This presentation is different from optic neuritis, which typically causes pain with eye movement and often occurs in younger patients with a demyelinating tendency. Central retinal vein occlusion also causes painless vision loss but the fundoscopic finding is a swollen, congested retina with widespread retinal hemorrhages (“blood and thunder”), not a pale retina with a cherry-red spot. Acute angle-closure glaucoma presents with a red, painful eye, rapidly elevated intraocular pressure, mid-dilated fixed pupil, and halos around lights—features not described here.

Thus, the described scenario aligns with central retinal artery occlusion.