Central Retinal Artery Occlusion - Cilioretinal Artery Sparing

These are photographs of a patient seen on 8-17-2017 for complaints of sudden vision loss in his right eye. His visual acuity was 20/20 in both eyes but he had a positive afferent pupillary defect (APD) in his right eye with constricted confrontational visual fields. The yellow arrows point to the borders of ischemic retinal whitening and preserved pink macula supplied by a spared cilioretinal artery. Central retinal artery occlusions (CRAOs) are caused by emboli usually originating from the carotid arteries that block the central retinal artery. With reduced blood flow, downstream arterioles narrow (blue arrows), which is associated with ischemic whitening of the retina (white arrows). In this case, his vision remained at 20/20 because there was cilioretinal artery sparing (black arrow). Optical coherence tomography scans (OCT’s) show hyperreflectivity of the inner retina layers related to the CRAO (pink arrows). 1-2 months later, the ischemic retinal whitening has largely resolved. OCTs show retinal atrophy and loss of definition of retinal layers. Continued observation is important for the first few months after the acute event to detect retinal or iris neovascularization.