Answer: The left eye fundus is significant for diffuse retinal whitening suggestive of ischemia, optic disc edema, and a cherry red spot. This is consistent with a central retinal artery occlusion.
Surprise! You are currently rotating at an institution with OCT available in the ED. This is what it shows:
Above image Credit: Kyle Hirabayashi, MD
How would you describe this OCT?
OCT macula of the left eye. Media appears clear, foveal contour well preserved. Retinal layers well delineated.
OCT macula of the left eye. Media appears clear, large cystic intraretinal fluid
OCT macula of the left eye. Media appears clear, foveal contour well preserved. Ellipsoid zone disruption
OCT macula of the left eye. Media appears clear, foveal contour well preserved, Retinal layers well delineated, but with hyperreflectivity of the inner retinal layers nasal to the macula.
Bonus question: What other conditions are associated with a cherry red spot on fundoscopic exam? Click all that apply.
Tay-Sachs
Niemann-Pick disease
Radiation retinopathy
Hydroxychloroquine retinopathy
Recognizing this an emergency, you activate the stroke protocol, and consult neurology.
What tests will the consultants want you to order? Click all that apply.
STAT CT head/angiography
MRI brain
CBC, ESR/CRP
Echocardiogram
Hypercoagulability work up
Click here to move on!
Ophtho On Call Case 2 Index
Ophtho On Call Case 2: Introduction
Ophtho On Call Case 2: Additional History and Physical Exam