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CRAO Retinal Stroke Dialysis — ESENeph MCQ

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ModerateHaemodialysisCRAO Retinal Stroke DialysisESENeph

A 60-year-old man with CKD G5D on HD develops acute onset visual field loss. He describes a curtain coming down over one eye. Fundoscopy by the on-call ophthalmologist shows a pale retina with a cherry-red spot and box-carring in retinal arterioles. What is the diagnosis?

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Correct answer: A — Central retinal artery occlusion (CRAO) – an ophthalmic emergency; CKD/dialysis patients have markedly increased cardiovascular and thromboembolic risk predisposing to retinal artery occlusion

CRAO causes sudden painless monocular vision loss from retinal ischaemia. The pale retina reflects ischaemic oedema; the cherry-red spot is the fovea (supplied by choroidal circulation, appearing red against the pale retina). Box-carring (segmental blood column in arterioles) indicates stasis. It is essentially a 'retinal stroke'. CKD/dialysis patients have 5-10 fold increased cardiovascular risk including retinal artery occlusion. Emergency management includes ocular massage, anterior chamber paracentesis (to lower IOP), and urgent investigation for embolic source (carotid Doppler, echocardiography). Visual prognosis is poor.

Reference: Royal College of Ophthalmologists – CRAO; ERA-EDTA 2019 – CV Risk