CENTRAL RETINAL ARTERY OCCLUSION AND NEW ONSET ATRIAL FIBRILLATION H Baldawi MD, K Obi MD. Department of Medicine, Ochsner Medical Center, New Orleans, LA INTRODUCTION Central Retinal Artery Occlusion (CRAO) is an ocular emergency, in which patients usually present with painless acute monocular blindness. Most cases are associated with an embolic ipsilateral carotid artery atherosclerosis. Other etiologies have also been identified such as valvular disease and giant cell arteritis. Atrial fibrillation (AF) is not well associated with CRAO. CASE: A 65-year-old man with coronary artery disease, hyperlipidemia, diabetes mellitus, hypertension presents with a 1-day historyof painless acute left eye vision loss. Thepatient deniedany recent heador eye trauma. In theemergencydepartment, the patient had pressure of 15 mmHg on tonometry and was noted to have hyperechoic strip concerning for possible retinal detachment. He had a cherry red spot and retina whitening on exam pointing to the diagnosis of central retinal artery occlusion (CRAO). The patient was noted to be in atrial fibrillation (AF) with rapid ventricular rate. He denied previous history of arrhythmias or AF. The patient was managed with Apixaban and Metoprolol and remained in sinus rhythm. Complete metabolic panel and complete blood count were unremarkable. Hemoglobin A1c was 6.1 and lipid panel were unremarkable. Transthoracic echocardiogram revealed a preserved ejection fraction (55 %), mild ventricular and bi-atrial enlargement, mitral valve with normal leaflets, and aortic valve with mild sclerosis. Carotid ultrasound revealed sluggish flow within right carotid artery only. Magnetic resonance imaging of the brain and neck were without hemodynamically significant stenosis of the neck vessel. AF was recognized as the possible culprit for CRAO in this case after ruling out common etiologies. DISCUSSION: This review emphasizes the importance of a thorough workup required in patients with retinal artery occlusions. The increase risk of incidental AF in patients with CRAO has been documented in different case reports and some cohort studies. Further investigation is needed to establish AF as one underlying cause of CRAO. Also, given that retinal vascular disease increases the risk for embolic disease in AF, incidental AF should be considered in some CRAO cases.
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