Sudden Vision Loss – What’s Your Approach?

MBBS
1

A 65-year-old hypertensive man presents with sudden, painless loss of vision in one eye.
No history of trauma. Fundoscopy shows cherry red spot.

What’s your top diagnosis? What investigations would you do next?

2

Central Retinal Artery Occlusion (CRAO)
Next investigation:-

  1. Immediate:
  • Ocular ultrasound (B-scan) → To rule out retinal detachment if fundus view is not clear
  • Fluorescein angiography → To confirm lack of retinal arterial filling
  1. Systemic:

  • Carotid Doppler ultrasound → Rule out embolic source from carotid atherosclerosis

  • Echocardiography (TTE or TEE) → Cardiac source of emboli (e.g., atrial fibrillation, valvular disease)

  • ECG → To detect atrial fibrillation or other arrhythmias

  • Blood tests:

    • CBC, ESR/CRP → Rule out giant cell arteritis, especially if > 50 yrs
    • Lipid profile, Blood sugar → Evaluate vascular risk factors
    • Coagulation profile → If suspecting hypercoagulability
3

Central Retinal Artery Occlusion

Tests:-
ESR, CRP, Fluorescein angiography, Carotid Doppler, lipid profile, coagulation profile

4

Central Retinal Artery Occlusion