Case of the Month October Answer
October 26, 2018
There was inferior retinal whitening in the right eye, indicating retinal edema from ischemia, and there was inferotemporal arterial sclerosis. There were also a few hemorrhages along the inferotemporal arcade. There was a calcific embolus in an inferior retinal artery overlying the inferior optic disc. The OCT showed inner edema consistent with an arterial occlusion. The fluorescein angiogram revealed inferior nonperfusion early, staining of the inferior arteries late, and no disc leakage.
These findings were consistent with an embolic branch retinal artery occlusion. The absence of disc leakage argued against an inflammatory process, and testing for nonspecific inflammatory markers was negative. CT angiography of the neck showed 40-50% stenosis of the right and left carotid arteries with calcified plaques.
The patient was advised to use a baby aspirin daily, and his condition is being monitored.
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