Detection of Central Retinal Artery Occlusion by Point-of-Care Ultrasound in the Emergency Department: A Case Series

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.

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Diagnosis of central retinal artery occlusion with point-of-care ultrasound

Visual Journal of Emergency Medicine ◽

10.1016/j.visj.2019.100657 ◽

2020 ◽

Vol 19 ◽

pp. 100657

Author(s):

Suman Gupta ◽

Kay Odashima ◽

Gregg Chesney

Keyword(s):

Point Of Care ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Point Of Care Ultrasound ◽

Retinal Artery

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

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2018.11.39406 ◽

2019 ◽

Vol 3 (1) ◽

pp. 13-15 ◽

Cited By ~ 1

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.

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

POCUS Journal ◽

10.24908/pocus.v6i2.14974 ◽

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.

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

Stroke ◽

10.1161/str.49.suppl_1.wp69 ◽

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

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Prevalence of SARS-CoV-2 among central retinal artery occlusion patients: A case series-HORA study report No. 3

Journal of Acute Disease ◽

10.4103/2221-6189.318644 ◽

2021 ◽

Vol 10 (4) ◽

pp. 147

Author(s):

SunnyChi Lik Au ◽

CallieKa Li Ko

Keyword(s):

Central Retinal Artery Occlusion ◽

Case Series ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Study Report ◽

Retinal Artery

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Current endovascular treatment options for central retinal arterial occlusion: a review

Neurosurgical FOCUS ◽

10.3171/2013.11.focus13331 ◽

2014 ◽

Vol 36 (1) ◽

pp. E7 ◽

Cited By ~ 9

Author(s):

Nitin Agarwal ◽

Nihar B. Gala ◽

Reza J. Karimi ◽

Roger E. Turbin ◽

Chirag D. Gandhi ◽

...

Keyword(s):

Endovascular Treatment ◽

Treatment Options ◽

Central Retinal Artery Occlusion ◽

Case Series ◽

Arterial Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Complication Rates ◽

Retinal Artery

Central retinal artery occlusion, although relatively rare, is an ophthalmological emergency. If left untreated, complete blindness will ensue. Conventional therapies have not significantly improved outcomes compared with the natural history of the disease. Several case series of more recent endovascular approaches, such as intraarterial fibrinolysis, report successful outcomes. Still other studies regarding intraarterial fibrinolysis do not demonstrate any significantly better outcomes, with some even indicating increased complication rates. Therefore, the authors present a review of the current endovascular treatment options for central retinal artery occlusion.

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