Snap Shot A 76-year-old man presents with sudden vision loss in his right eye. He described the onset as if a curtain came down over his eye. He has a medical history of hypertension and coronary artery disease. On physical exam a carotid bruit is heard. A retinal exam is performed. Introduction Embolic occlusion of the retinal artery resulting in vision loss If the plaque is small and vision spontaneously returns with passage of the clot, it is termed amaurosis fugax Most commonly seen in elderly patients with carotid plaques Presentation Symptoms sudden, painless, and complete loss of vision in one eye Physical exam pallor of the optic disc cherry-red macula edema of the retina constricted and bloodless retinal arterioles boxcar segmentation of the blood in the retinal veins carotid bruits can often be auscultated Diagnostic tests evaluate the carotid artery Doppler CTA/MRA Treatment Surgical decompression of the retinal anterior chamber ideally in less than one hour after occlusion functions to reduce intraoccular pressure If surgical intervention is not readily available digital massage of globe CO2 rebreathing & ocular massage both function to dilate retinal vessels in an attempt to pass the clot into a distal segment of the occluded vessel Prognosis, Prevention, and Complications Permanent damage to the eye if not treated rapidly