J Korean Ophthalmol Soc.  2016 Feb;57(2):324-329. 10.3341/jkos.2016.57.2.324.

Central Retinal Artery Occlusion after Trauma: Report of Two Cases

• Koh JS
• Woo SJ

• KMID: 2213676
• DOI: http://doi.org/10.3341/jkos.2016.57.2.324

Abstract

PURPOSE
To report two patients who developed central retinal artery occlusion (CRAO) after trauma.
CASE SUMMARY
A 26-year-old man complained of severe loss of vision in his left eye after falling and bumping his forehead on a staircase. His visual acuity was light perception in the left eye. Fundus examination revealed edematous white retina and a cherry red spot on the macula. Angiography showed severe stenosis in the initial segment of the ophthalmic artery with ophthalmic arterial embolus. He underwent intra-arterial thrombolysis with a clinical diagnosis of CRAO with ophthalmic artery stenosis. A 57-year-old woman presented with vision loss after falling and striking her face below her right lower eyelid on a wooden stick. Her visual acuity was hand motions in the right eye. Fundus examinations showed white retina with opacity and a cherry red spot on the macula. Fluorescein angiography and optical coherence tomography was performed, and a clinical diagnosis of CRAO was made.
CONCLUSIONS
CRAO must be considered when clinically differentiating visual loss after a trauma.

Keyword

Central retinal artery occlusion; Intra-arterial thrombolysis; Trauma

MeSH Terms

Adult
Angiography
Constriction, Pathologic
Diagnosis
Embolism
Eyelids
Female
Fluorescein Angiography
Forehead
Hand
Humans
Middle Aged
Ophthalmic Artery
Prunus
Retina
Retinal Artery Occlusion*
Retinal Artery*
Strikes, Employee
Tomography, Optical Coherence
Visual Acuity

Figure

• 

  Figure 1. Patient case 1. (A) Fundus photography before intra-arterial thrombolysis in case 1. There was edematous retina with typical cherry-red spot and fragmentation of retinal vessels compatible with central retinal artery occlusion. (B) Computed tomographic images showing left frontal sinus posterior wall fracture (arrow). (C) Arterial phase of left carotid angiogram (arrow). (D) There was severe stenosis of ophthalmic artery (arrow). (E) One day after intra-arterial thrombolysis. (F) Retinal arterial and venous filling was normalized except in the central macular region.

• 

  Figure 2. Patient case 2. Fundus photography (A) and fluorescein angiography (B) in case 2. Retinal arterial filling was markedly delayed with arterio-venous transit time of 50 secs. (C) Computed tomographic images showing right multifocal retrobulbar hemorrhage (arrow). Fundus photography (D) and optical coherence tomography (E) 15 months after trauma. Disc pallor and inner retinal atrophy was observed.

Reference

1). Hayreh SS, Zimmerman MB. Central retinal artery occlusion: visual outcome. Am J Ophthalmol. 2005; 140:376–91.

2). Park SJ, Choi NK, Seo KH, et al. Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011. Ophthalmology. 2014; 121:1933–8.

3). Lee JH, Moon HS, Nam DH, Lee DY. Treatment of acute central retinal artery occlusion with ocular ischemic syndrome. J Korean Ophthalmol Soc. 2014; 55:1242–7.

4). Kim KE, Ahn SJ, Woo SJ, et al. Central retinal artery occlusion caused by fat embolism following endoscopic sinus surgery. J Neuroophthalmol. 2013; 33:149–50.

5). Park SW, Woo SJ, Park KH, et al. Iatrogenic retinal artery occlusion caused by cosmetic facial filler injections. Am J Ophthalmol. 2012; 154:653–62. e1.

6). Jung EH, Park KH, Woo SJ. Iatrogenic central retinal artery occlusion following retrobulbar anesthesia for intraocular surgery. Korean J Ophthalmol. 2015; 29:233–40.

7). Nakao Y, Terai H. Embolic brain infarction related to posttraumatic occlusion of vertebral artery resulting from cervical spine injury: a case report. J Med Case Rep. 2014; 8:344.

8). Tabarki B, Alvarez H, et al. Ischemic cerebral vascular accident caused by vertebral artery dissection. Arch Pediatr. 1997; 4:763–6.

9). Scheerlinck TA, Brande P. Post-traumatic intima dissection and thrombosis of the external iliac artery in sportsman. Eur J Vasc Surg. 1994; 8:645–7.

10). Poon H, Patel A, Vijay S, Downing R. Endovascular repair for left common iliac artery occlusion following blunt trauma without associated bony injury: image in vascular surgery. Vasc Endovascular Surg. 2012; 46:179–80.

11). Singla AA, McPherson D, Singla AA, et al. External iliac artery occlusion in a paediatric patient following handlebar trauma. J Surg Case Rep. 2015; 2015. pii: rjv015.

12). Sodhi KS, Arora J, Khandelwal N. Post-traumatic occlusion of subclavian artery with clavicle fracture. J Emerg Med. 2007; 33:419–20.

13). Narang S, Kochhar S, Gupta S, et al. Bilateral simultaneous central retinal artery occlusion following head injury. Int Ophthalmol. 2007; 27:387–90.

14). Ghose S, Subhabrata P. Bilateral central retinal arterial obstruction following head trauma: a very rare case report. Indian J Ophthalmol. 2011; 59:66–8.

15). Cha DM, Lee T, Choe G, et al. Silent giant cell arteritis in an elderly Korean woman. Korean J Ophthalmol. 2013; 27:224–7.

16). Dalma-Weiszhausz J, Regil A, Martinez-Jardón S, Oliver-Fernández K. Retinal vascular occlusion following ocular contusion. Graefes Arch Clin Exp Ophthalmol. 2005; 243:406–9.

17). Schmidt D, Hetzel A, Geibel-Zehender A, Schulte-Mönting J. Systemic diseases in non-inflammatory branch and central retinal artery occlusion--an overview of 416 patients. Eur J Med Res. 2007; 12:595–603.

18). Stein PD, Yaekoub AY, Matta F, Kleerekoper M. Fat embolism syndrome. Am J Med Sci. 2008; 336:472–7.

19). Goldsmith MO. Occlusion of the central retinal artery following retrobulbar hemorrhage. Ophthalmologica. 1967; 153:191–6.

20). Moshfeghi DM, Lowder CY, Roth DB, Kaiser PK. Retinal and choroidal vascular occlusion after posterior sub-tenon triamcinolone injection. Am J Ophthalmol. 2002; 134:132–4.

21). Varma DD, Cugati S, Lee AW, Chen CS. A review of central retinal artery occlusion: clinical presentation and management. Eye (Lond). 2013; 27:688–97.

22). Ahn SJ, Woo SJ, Park KH, et al. Retinal and choroidal changes and visual outcome in central retinal artery occlusion: an optical coherence tomography study. Am J Ophthalmol. 2015; 159:667–76.