A 75-year-old woman with diabetes mellitus and congestive heart failure have a sudden loss of vision in her left eye. Funduscopic examination shows a cherry-red appearance of the foveola, whereas the remaining retina appears pale. No abnormalities of the right eye are noted. Which of the following is the most likely cause for her sudden unilateral visual loss?
Thromboembolization from the diseased heart to the central retinal artery causes a diffuse retinal infarct that obscures the underlying vascular choroid, except where the retina is thinner in the fovea so that it appears red compared to the surrounding pale retina. The other listed choices are typically bilateral processes. Cytomegalovirus retinitis has edematous and hemorrhagic lesions; it is most often seen in immunocompromised patients. Primary angle-closure glaucoma typically occurs in hyperopic eyes, and some cases may be acute, with eye pain from elevated intraocular pressure. Proliferative retinopathy can occur with diabetes mellitus, but the major change is retinal neovascularization. Tay-Sachs disease is seen in infancy and early childhood produces a cherry-red spot because the fovea in the center of the macula is relatively spared; it contains few ganglion cells that contain the storage product.
Central retinal artery occlusion
Cytomegalovirus retinitis
Primary angle-closure glaucoma
Proliferative retinopathy
Misc.