Adult Woman With Tunnel Vision

A 39-year-old woman presented to the emergency department with sudden onset of painless tunnel vision in the right eye 4 hours ago. As a child, she underwent valve surgery for a cardiac anomaly. Her vision was 20/100 in the right eye and 20/20 in the left eye, with constricted right confrontational fields. The slit-lamp examination was normal. Right-sided fundoscopy was performed (Figure 1). Central retinal arterial occlusion with cilioretinal artery sparing. Fundoscopy demonstrated diffuse retinal whitening but good retinal perfusion between the nerve and fovea. There was diffuse retinal arterial attenuation and segmentation. Although carotid echography did not demonstrate internal carotid artery stenosis, magnetic resonance angiography showed a focal stenosis at the right posterior cerebral artery and P2 segment, and cardiac echography demonstrated a dilated aortic root and tricuspid aortic valve with calcification and moderate regurgitation. At the 3-month follow-up, the patient’s visual acuity remained 20/100, and the whitish retina resolved with a pale optic disc (Figure 2). Retinal artery occlusions are often due to blockages of retinal blood flow from an embolus. Occasionally, there can be sparing of a cilioretinal artery, which may help maintain some central vision. Central retinal artery occlusion risk factors include hyperlipidemia, hypertension, diabetes, and cardiovascular disease, including valvular disorders.1Callizo J. Feltgen N. Pantenburg S. et al.Cardiovascular risk factors in central retinal artery occlusion: results of a prospective and standardized medical examination.Ophthalmology. 2015; 122: 1881-1888Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar, 2Hayreh S.S. Ocular vascular occlusive disorders: natural history of visual outcome.Prog Retin Eye Res. 2014; 41: 1-25Crossref PubMed Scopus (193) Google Scholar, 3Yousuf S.J. Guiseppi R. Katz D.M. et al.Emergency department presentation of retinal artery occlusion.Ophthalmol Retina. 2022; 6: 318-324Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar