Detection of Central Retinal Artery Occlusion by Point-of-Care Ultrasound in the Emergency Department: A Case Series

Abstract

Central retinal artery occlusion (CRAO) is a rare, but serious, diagnosis that can lead to blindness, most often due to thromboembolic disease. In the emergency department (ED), CRAO can present as acute, painless loss of vision. Physicians need quick ways to rule in this diagnosis due to the time-sensitive nature of the event. We describe two patients in this cases series who present to the same ED with unilateral painless vision loss and histories that include notable risk factors such as thromboembolic and atherosclerotic disease. Upon arrival, point-of-care ultrasound (POCUS) done at the bedside allowed for quick determination of CRAO. The importance of this case series is to emphasize the efficacy of POCUS in evaluating patients with painless vision loss in the ED setting.

Central retinal artery occlusion or retinal stroke: a neurosonologist’s perspective

“…Since review articles with information on practical ultrasound applications in diagnosing retinal ischemia are lacking ( 7 , 14 , 16 ), we agree with the other authors that the message regarding the possible practical utility of Neuro-POCUS in diagnosing CRAO requires wider dissemination ( 64 ). Furthermore, one in three ophthalmologists reported that they would not transfer their patients with CRAO to a stroke center ( 21 ), thus leaving the patients at risk of future stroke or other cardiovascular conditions.…”

Imaging Correlation of a Carotid Embolus in Central Retinal Artery Occlusion (CRAO)

“…This classic presentation should immediately raise suspicion of an acute stroke and therefore prompt rapid diagnosis, workup, and treatment. Unfortunately, there is often a delay in diagnosis secondary to patients' time of presentation and challenges with obtaining appropriate ophthalmic funduscopic evaluation emergently [5]. Point of care ultrasound may be of greater utility in aiding the diagnosis, especially in a setting where access to emergent ophthalmic care and evaluation is limited [6].…”