Image Based Question – 68243

A 56 year-old female presents with sudden onset loss of vision in her right eye. She a past medical history of hypertension, hyperlipidema and medication-controlled diabetes mellitus type 2. Her medications include aspirin, ramipril, atorvastation and metformin. On examination she has 6/60 vision in her right eye.Fundoscopic picture is given in the image.What is the most probable diagnosis?

A. CRAO

B. CRVO

C. Diabetic retinopathy

D. Hypertensive retinopathy

Show Answer

Correct Answer » B Explanation

Ans:B. CRVO

‘Blood and thunder’ retinal appearance is shown in the image.

Central retinal vein occlusion (CRVO)

Predisposing factors:

• glaucoma

• old age

• hypertension

• diabetes mellitus

• hypercoagulable state

• atherosclerosis (vein is compressed by adjacent artery)

• retrobular compressive lesions (e.g. thyroid disease, orbital tumour)

• vasculitis

Examination:

• Visual acuity — variable depending on severity and duration since onset

• A Marcus-Gunn pupil may be present if ischemic CRVO (relative afferent pupillary defect = RAPD)

• Red reflex — may be abnormal

• Fundoscopy — large areas of hemorrhage:

• non-ischemic CRVO — dilated tortuous veins, retinal hemorrhages, cotton wool spots, retinal edema, disc swelling.

• ischemic CRVO (more severe) — classic ‘blood and thunder’ appearance from widespread hemorrhages that obscure most fundal details. Neovascularisation.