case report - crao : ophthalmic emergency

This is a case report of central retinal artery occlusion, an ophthalmic emergency that needs to treated as soon as possible to prevent blindness

1. CENTRAL RETINAL ARTERY OCCLUSION (CRAO) CASE PRESENTATION PRESENTED BY: KAJAL DUDEJA AND JATIN YADAV YEAR OF STUDY : MBBS final prof . part-I COLLEGE : NC Medical College , Panipat

2. CASE DESCRIPTION PATIENT DETAILS : NAME : Mr. VP AGE : 50 years GENDER : Male OCCUPATION : Farmer ADDRESS : Rural area of district Panipat SOCIO-ECONOMIC STATUS : Lower middle class as per Modified Kuppuswamy scale DATE OF EXAMINATION : 23/07/2023

3. CHIEF COMPLAINTS : Sudden , painless and persistent loss of vision in his left eye since 1 day Intermittent fever since 1 day Moderate headache since 1 day

4. HISTORY OF PRESENTING ILLNESS : The patient was apparently normal 1 day ago, then he developed loss of vision in his left eye. It was sudden in onset and painless and persistent in nature. It was accompanied with headache and fever.

5. PAST HISTORY : No h/o any systemic conditions. OCULAR HISTORY: No history of previous surgeries to right or left eye.

6. PERSONAL HISTORY : Diet : Mixed Appetite : Adequate Sleep pattern : Normal Bowel/Bladder habits : regular and normal Habit : No H/O smoking and drinking FAMILY HISTORY: Not significant

7. EXAMINATION GENERAL PHYSICAL EXAMINATION : Patient is a 50 year old male, moderately built and nourished . He is conscious , cooperative and well oriented to time , place and person . Temperature : Afebrile on touch

8. VITALS AT ADMISSION : Pulse : 86/min BP : 132/60 mmHg RESPIRATORY RATE : 18 Cycles/min SPO2 : 98 He exhibits no evidence of – 1. palor 2. icterus 3. cyanosis 4.clubbing 5.lymphadenopathy 6. edema

9. EXAMINATION OF EYE Head posture is mainatined Facial symmetry maintained Ocular posture maintained

10. LOCAL EXAMINATION : RIGHT LEFT VISUAL ACUITY (UCVA) 6/9 Perception of light positive an d projecion of rays accurate in all quadrants. 2. IOP(mmHg) 15.5 13.5 3. LID AND ADNEXA Normal Normal 4. CONJUCTIVA Normal color and texture Normal color and texture 5. CORNEA Clear Clear

11. RIGHT LEFT 6.ANTERIOR CHAMBER Normal color and density Van Herick grade 3 Optically clear Normal color and density Van Herick grade 3 Optically clear 7. IRIS Normal color and pattern Normal color and pattern 8. PUPIL Round , regular , reacting to light Round Mid dilated Sluggish reacting to light 9. LENS Clear Clear

12. RIGHT LEFT 10. FUNDUS Optic disc normal in size and shape with well defined margins CDR ratio 0.4 Foveal reflex present Mild pallor of optic disc. CDR ratio 0.4 Segmented temporal blood vessels known as “ BOX-CARRING” Reddish glow suggestive of CHERRY RED SPOT AT MACULA

13. DIFFERENTIAL DIAGNOSIS BASED ON HISTORY : CENTRAL RETINAL ARTERY OCCLUSION RETINAL DETATCHMENT VITEROUS HAEMORRHAGE COMMOTIO RETINAE VENOUS OCCLUSION BASED ON EXAMINATION : CENTRAL RETINAL ARTERY OCCLUSION

14. FINAL DIAGNOSIS : CENTRAL RETINAL ARTERY OCCLUSION (CRAO )

15. MANAGEMENT A s we know CRAO is an ocular emergency, immediate management is required. Ocular massage Anterior chamber paracentesis Tab.Acetazolamide 500mg Vasodilators Topical NSAIDs : Nepafenac 0.1% THESE WERE GIVEN IMMEDIATELY .

16. As the patient stabilised , we took further history and screened for and excluded other cardiovascular and neurological abnormalities . OTHER INVESTIGATIONS Medical investigations: Pulse BP Carotid evaluation : Doppler evaluation ECG Blood : complete blood count and ESR fasting glucose and lipids 2.In some selected patients , other special investigations are required which inludes : Echocardiogram , MR angiography , homocysteine levels,thrombophlia screening (was not necessary in this patient)

17. FOLLOW-UP Patient was asked to report immediately if he experience similar episode again. Follow up of the patient was requested at 1 month and 6month to evaluate the condition of fundus and retinal artery On 25 August 2023 , patient was examined: F undus examination reveal ghost blood vessel and retinal thinning present. All vitals were normal Blood tests were normal

18. Central retinal artery is subjected to IOP changes. Risk factors of occlusion – hypertension and other cardiovascular abnormalities. Emboli(mc: Hollenhorst plaques), atherosclerosis,raised IOP,thrombophilic disorers constitute main causes. Usualy unilateral with predominance in males . EXPLANATION

19. CONCLUSION CRAO is an ophthalmic and medical emergency. Causes and risk factors - similar cerebrovascular events Patients must be evaluated promptly for stroke to minimise secondary ischemic events. Despite grim prognosis , efforts to restore vision should be instituted , within 4 hours of symptoms.

20. THANK YOU