Ophthalmic artery aneurysm: potential culprit of central retinal artery occlusion

Abstract

Central retinal artery occlusion (CRAO) is one of the most devastating ophthalmic emergencies, causing acute painless visual loss in the affected eye. We describe the first case of acute non-arteritic CRAO associated with peripheral ophthalmic artery aneurysm and its clinical course after intra-arterial thrombolysis therapy. This case suggests that ophthalmic artery aneurysm can be the cause of CRAO and should be included in the differential diagnosis of CRAO.

Keywords: Ophthalmic artery aneurysm; Retinal artery occlusion.

Fig. 1

Internal carotid artery angiogram and three dimensional reconstructed image of the ophthalmic artery. (A) The internal carotid artery angiogram shows patent ophthalmic artery (arrow). (B) Three dimensional reconstructed view of the ophthalmic artery (arrow head) identifies its origin from the 3.7 × 4.5 × 5.2 mm sized aneurysm (arrow).

Fig. 2

Fundus photography, fluorescein angiography and spectral-domain optical coherence tomography (SD-OCT) after intra-arterial thrombolysis. (A) One day after thrombolysis, the retina was still edematous with a typical "cherry red spot" appearance but showed improved vascularity. (B) Retinal arterial filling showed normal arterio-venous transit time of 11 seconds (left 20 seconds, right 31 seconds). (C) SD-OCT showed increased thickness and reflectivity of the inner retina typical of central retinal artery occlusion. (D) After 4 months of treatment, the inner retina thickness had markedly decreased.