Central Retinal Artery Occlusion - "Stuttering" Type

This 65-year old patient presented with complaints of sudden onset of blurry vision in the right eye for five days. Dilated exam showed an optic disc hemorrhage (green arrow, left panel) and cotton wool spots. (blue arrow). The findings are suggestive, but not conclusive for a central retina artery occlusion. She had no jaw claudication, headache, or proximal myalgias to suggest temporal arteritis. Her carotid arteries were evaluated but showed no atherosclerotic lesions or significant hemodynamic obstruction. The patient was asked to follow up in one month, control blood pressure and see her primary care physician to arrange for an echocardiogram to look for potential sources of emboli. The one-month follow-up showed a resolved disc neural rim hemorrhage and cotton wool spots.