A 75-year-old woman with diabetes mellitus and congestive heart failure has sudden loss of vision in her left eye. Funduscopic examination shows a “cherry red” appearance of the foveola while the remaining retina appears pale. No abnormalities of the right eye are noted. Which of the following is the most likely cause for her sudden unilateral visual loss?
|A.||Central retinal artery occlusion|
|C.||Primary angle closure glaucoma|
Answer : A Central retinal artery occlusion
She likely has thromboembolization from her diseased heart to the central retinal artery causing a diffuse retinal infarct that obscures the underlying vascular choroid, except where the retina is thinner in the fovea, so that it appears red compared to the surrounding pale retina.
The other listed foils are typically bilateral processes. Cytomegalovirus retinitis has edematous and hemorrhagic lesions; it is most often seen in immunocompromised patients.
Primary angle closure glaucoma typically occurs in hyperopic eyes, and some cases may be acute, with eye pain from elevated intraocular pressure.
Proliferative retinopathy can occur with diabetes mellitus, but the major change is retinal neovascularization.