scholarly journals Diagnosis of Central Retinal Artery Occlusion in the Emergency Department Using POCUS: A Case Series

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 73-75
Author(s):  
Nicholas Cozzi ◽  
Kendall Stevens ◽  
Yeoshina Pillay ◽  
David Moore ◽  
Matthew Flannigan ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Vision Loss ◽  
Treatment Algorithm ◽  
Central Retinal Artery Occlusion ◽  
Case Series ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Point Of Care Ultrasound ◽  
Retinal Artery

Introduction: Central Retinal Artery Occlusion is a cause of vision loss that warrants emergent evaluation. Ocular Point of Care Ultrasound (POCUS) is a non-invasive, inexpensive, and rapid modality to establish diagnosis with reduced time to consultation and treatment. Methods: This was a retrospective case series of patients evaluated at seven hospitals with diagnosis of CRAO over a two-year period. All patients underwent ocular POCUS performed by an emergency medicine clinician.  Results: Nine patients were evaluated with mean vision loss of 21 hours. Overall, 88% of patients were diagnosed with CRAO, 75% possessing US confirmed retrobulbar spot sign (RBBS), and 38% confirmed diagnosis with fundoscopy. Conclusion: Ocular POCUS is an examination all emergency medicine clinicians should be able to perform. A rapid diagnosis of CRAO provides opportunity for vision improvement with initiation of treatment. The lack of guidelines for treatment of CRAO represents an opportunity for a multi-speciality collaboration to develop a diagnostic and treatment algorithm.

scholarly journals Early Identification of Central Retinal Artery Occlusion Using Point-of-care Ultrasound

2019 ◽  
Vol 3 (1) ◽  
pp. 13-15 ◽  
Author(s):  
Ben Stoner-Duncan ◽  
Stephen Morris
Keyword(s):  
Vision Loss ◽  
Point Of Care ◽  
Tertiary Care ◽  
Central Retinal Artery Occlusion ◽  
Stable Condition ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Point Of Care Ultrasound ◽  
Retinal Artery

A 69-year-old woman with a history of untreated hypertension presented with acute-onset monocular vision loss. Initial workup was delayed due to lack of immediate specialty consultation and dilated funduscopic exam. Point-of-care ultrasound in the emergency department identified a small hyperechoic structure within the distal area of the central retinal artery; in conjunction with specialty ophthalmologic evaluation in a tertiary care center, the diagnosis of central retinal artery occlusion was made. The patient was admitted to the neurology service for stroke risk stratification and was discharged in stable condition with re-initiation of her antihypertensive medication regimen.

scholarly journals The use of multimodal imaging in the evaluation of a patient with central retinal artery occlusion in the setting of asteroid hyalosis: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Timothy M. Janetos ◽  
Olga German ◽  
Rukhsana Mirza
Keyword(s):  
Multimodal Imaging ◽  
Vision Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Timely Diagnosis ◽  
Cardiovascular Morbidity And Mortality ◽  
Asteroid Hyalosis ◽  
Retinal Artery

Abstract Background A central retinal artery occlusion (CRAO) is an ophthalmic emergency due to its strong association with cerebrovascular and cardiovascular morbidity and mortality. A timely diagnosis is necessary but difficult in the setting of dense asteroid hyalosis, as typical fundoscopic findings can be obscured. We present a case where multimodal imaging in an eye with an obscured fundus could lead to timely diagnosis and management of CRAO in a patient with acute vision loss. Case presentation A 94-year-old Caucasian woman with a history of exudative macular degeneration presented to the retina clinic with acute vision loss in one eye over the course of an afternoon. The patient had dense asteroid hyalosis, and a direct retinal exam was not possible. Multimodal imaging suggested a CRAO diagnosis. The patient received digital ocular massage directly prior to undergoing fluorescein angiography (FANG), which confirmed the diagnosis. The patient was transported from clinic to the emergency room for an emergency stroke workup, which revealed a spontaneous echo in the left atrial appendage, and the patient was started on antiplatelet therapy. When she presented for follow-up within a week, the patient noted that her vision had improved at the time of digital ocular massage and continued to improve thereafter. Her FANG showed marked reperfusion of the retina, and she subsequently has completely regained her baseline visual acuity. Conclusions Multimodal imaging is useful in evaluating visual loss in patients with acute vision loss. In addition, ocular massage is a simple, low-risk intervention that may have benefit in the treatment of acute CRAO. Patients who present to ophthalmologists with an acute CRAO need an emergency referral for evaluation of cerebrovascular and cardiovascular comorbidities.

scholarly journals Case Report: Central Retinal Artery Occlusion in a COVID-19 Patient

2020 ◽  
Vol 11 ◽  
Author(s):  
Andrea Montesel ◽  
Claudio Bucolo ◽  
Victoria Mouvet ◽  
Emmanuelle Moret ◽  
Chiara M. Eandi
Keyword(s):  
Vision Loss ◽  
Previous History ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
History Of ◽  
Severe Vision Loss ◽  
Retinal Artery ◽  
Vascular Occlusions

We report a case of central retinal artery occlusion (CRAO) in a patient with a previous history of severe COVID-19 disease. This disease has been associated with inflammatory-induced homeostasis changes leading to endothelial dysfunction and a procoagulant state with multi-organ involvement, but the burden of thromboembolic complications in COVID-19 patients is currently unknown. The pathogenesis of retinal artery occlusions is a multifactorial process where inflammation and hypercoagulation state are established risk factors. Even if our experience may represent a coincidental relationship, it is likely that COVID-19 patients could be at risk of developing retinal vascular occlusions. A focused ophthalmological surveillance is advisable to prevent and manage this possible cause of severe vision loss that has an important impact in health care system.

Bilateral Central Retinal Artery Occlusion in Infective Endocarditis

2020 ◽  
pp. 247412642096090
Author(s):  
Mohamed Mohamed ◽  
Tahira Scholle
Keyword(s):  
Infective Endocarditis ◽  
Vision Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Motion Vision ◽  
Hand Motion ◽  
Cherry Red Spot ◽  
Retinal Artery

Purpose: This report describes a patient with bilateral, sequential central retinal artery occlusions (CRAOs) due to infective endocarditis (IE). Methods: A case report is presented. Results: A 35-year-old man with IE who recently completed a course of intravenous antibiotic therapy presented with sudden right-eye vision loss. Examination revealed hand motion vision, a cherry-red spot in the macula in the right eye, and an embolus in the inferotemporal arcade of the left eye. The diagnosis of right-eye CRAO secondary to IE was made, with the presumed source being his dental caries. The patient was admitted with plans for aortic valve replacement and dental extraction. During his hospitalization, the patient suffered from a CRAO in his left eye, resulting in bilateral loss of vision. Conclusions: IE can have severe embolic complications; prompt diagnosis and treatment medically and surgically are necessary to reduce further morbidity and mortality.

Central retinal artery occlusion from Streptococcus gallolyticus endocarditis

2020 ◽  
Vol 13 (9) ◽  
pp. e235763
Author(s):  
Rita Serras-Pereira ◽  
Diogo Hipolito-Fernandes ◽  
Luísa Azevedo ◽  
Luísa Vieira
Keyword(s):  
Vision Loss ◽  
Central Retinal Artery Occlusion ◽  
Transoesophageal Echocardiography ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Streptococcus Gallolyticus ◽  
Cardiovascular Comorbidities ◽  
Cherry Red Spot ◽  
Retinal Artery

Central retinal artery occlusion (CRAO) is a rare but blinding disorder. We present a case of a 81-year-old woman with multiple cardiovascular comorbidities admitted to the emergency department due to sudden, painless vision loss on left eye (oculus sinister (OS)) on awakening. The patient also reported long standing fatigue associated with effort that started 4 months before admission. She presented best corrected visual acuity of counting fingers OS. Funduscopy OS revealed macular oedema with cherry red spot pattern. Blood cultures came positive for Streptococcus gallolyticus in the context of a bacteremia and native mitral valve vegetation identified on transoesophageal echocardiography. CRAO of embolic origin was admitted in the context of an infective endocarditis. CRAO can be the first manifestation of a potentially fatal systemic condition and thus multidisciplinary approach is warranted with close collaboration between ophthalmologists and internists in order to provide proper management and the best possible treatment.

scholarly journals Painless loss of vision: rapid diagnosis of a central retinal artery occlusion utilizing point-of-care ultrasound

2021 ◽  
Vol 2021 (6) ◽  
Author(s):  
Gregory M Taylor ◽  
Daniel Evans ◽  
Robert P Doggette ◽  
Ryan C Wallace ◽  
Andrew T Flack ◽  
...  
Keyword(s):  
Point Of Care ◽  
Posterior Vitreous Detachment ◽  
Central Retinal Artery Occlusion ◽  
Vitreous Hemorrhage ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Point Of Care Ultrasound ◽  
Loss Of Vision ◽  
Retinal Artery

ABSTRACT Point-of-care ultrasound (POCUS) has become an essential part of the evaluation of vision loss among emergency physicians in the emergency department (ED). It is frequently used to evaluate for vitreous hemorrhage, foreign bodies, retinal detachment, optic neuritis and posterior vitreous detachment; however, it can also be used to evaluate for a central retinal artery occlusion (CRAO). A POCUS can reveal a hyperechoic density in the optic nerve sheath just proximal to the retinal surface, and this is referred to as a retrobulbar ‘spot sign’ (RBSS). We present the case of an 88-year-old male that presented to our community ED with a painless loss of vision to his right eye. A POCUS revealed an RBSS of the central retinal artery and he was subsequently diagnosed with a CRAO. At his 1-month follow-up, he has regained light perception and 15% of his vision, however, remains with significant visual impairment.

Abstract WP69: Guideline-Based Intravenous rPA for Central Retinal Artery Occlusion: A Case Series and Systematic Review

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Mohammed Alkuwaiti ◽  
Connie Bongiorno ◽  
Kevin Engel ◽  
Shailesh Male ◽  
Christopher Logue ◽  
...  
Keyword(s):  
Systematic Review ◽  
Central Retinal Artery Occlusion ◽  
Case Series ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Retinal Artery

Intra-Arterial Thrombolytic Therapy Is Not a Therapeutic Option for Filler-Related Central Retinal Artery Occlusion

2018 ◽  
Vol 34 (03) ◽  
pp. 325-329 ◽  
Author(s):  
Yi-Chun Chen ◽  
Hsiu-Mei Wu ◽  
Shih-Jen Chen ◽  
Han-Jui Lee ◽  
Jiing-Feng Lirng ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Vision Loss ◽  
Therapeutic Option ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Dermal Filler ◽  
Facial Filler ◽  
Retinal Artery

AbstractCosmetic facial filler-related central retinal artery occlusion (CRAO) is a devastating complication of facial hyaluronic acid (HA) injection and can be managed by intra-arterial thrombolytic therapy (IATT). The authors report on a 20-year-old woman who developed unilateral CRAO due to facial HA injection and who, despite prompt IATT, lost vision. A review of the related literature found 14 other female patients who developed cosmetic facial filler-related CRAO and accepted IATT management. In no case was vision loss clinically improved. IATT is not an effective preventive treatment of dermal filler-associated CRAO. The authors suggest careful preprocedural patient selection to prevent this complication.

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