Choice “B” is the best answer. This patient likely has CRVO, which presents with a sudden painless monocular
loss in vision. Some patients may be have dense scotomas (dark spots) as opposed to a total loss in their vision.
Preceding the visual loss or dense scotomas, the patient may recall episodes of transient vision loss or blurry
vision. The risk factors associated with the development of CRVO include advanced age, hypertension, diabetes,
smoking, obesity and a hypercoagulable disorder (e.g. PV). Glaucoma is also a major risk factor. In this patient,
her history of diabetes, advanced age, hypertension, and polycythemia vera all predispose her to the
development of CRVO.
CRVO is an important clinical entity given that diagnosis as it is the second most
…show more content…
Note that
this patient’s right eye has a severe CRVO – dilated veins and widespread retinal hemorrhages. Compared with
the patient’s left retina (image on the right) in which there are no retinal hemorrhages
Choice “A” is not the best answer. CRAO develops when an embolusi blocks the retinal artery. Most commonly
carotid plaques are the source of the emboli. If the plaque is small, it can often pass through the blood vessel
allowing the vision to spontaneously return. When this occurs it is termed amaurosis fugax. Symptoms are
similar to CRVO; a sudden, painless and complete loss of vision in one eye is the most common presentation. The
Funduscopic examination is instrumental as it demonstrates pallor of the optic disc, a cherry red macular,
edema of the retina, constricted and bloodless retinal arterioles and/or “boxcar” segmentation of the blood in
the retinal veins. Carotid bruits are often found on clinical examination. Immediate recognition and treatment is
necessary to preserve the patient vision. Surgical decompression of the retinal anterior chamber is the
treatment of