CRAO in SLE — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicineCRAO in SLERACP Adult Medicine

A 50-year-old woman with SLE develops sudden onset painless loss of vision in one eye. Fundoscopy shows a cherry-red spot at the macula with surrounding pale, oedematous retina and attenuated retinal arterioles. What is the diagnosis?

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Correct answer: C — Retinal detachment

A cherry-red spot at the macula with surrounding pale retina and attenuated arterioles is the classic fundoscopic finding of central retinal artery occlusion (CRAO). In SLE, this can result from antiphospholipid antibody-mediated thrombosis, vasculitis, or cardioembolism. CRAO is an ophthalmic emergency – retinal ischaemia causes irreversible damage within 90 minutes. Immediate ophthalmology referral is essential. Treatments attempted include ocular massage, anterior chamber paracentesis, and intra-arterial tPA, but evidence for efficacy is limited.

Reference: eTG – 2025 – Neurology; eTG – 2025 – Rheumatology