A misfortune never comes alone: A case of bilateral central retinal artery obstruction with patent foramen ovale

Poster Details

First Author: S.Parreira PORTUGAL

Co Author(s):    D. Lopes   S. Barros   N. Marques   F. Freitas   N. Campos                 

Abstract Details


Central retinal artery occlusion (CRAO) is an infrequent and severe ocular disease with poor prognosis. Bilateral involvement is rare. This case report a patient with bilateral CRAO probably caused by paradoxical embolism through a patent foramen ovale (PFO).


Department of Ophthalmology, Hospital Garcia de Orta EPE, Almada, Portugal


A 71-year-old woman presented at the emergency room with complaints of sudden painless vision loss in the both eyes, 8 hours before recourse. She referred having headache the day before. Past medical history included systemic hypertension, hypercholesterolemia and breast cancer with mastectomy. Best corrected visual acuity was light perception in OU. Fundoscopy disclosed CRAO in OU with a cherry-red spot observed in the macula. During our observation the patient suffered severe bradycardia and loss of consciousness. Systemic workup was completed by internal medicine and a cardiologist.


Complete blood count, erythrocyte-sedimentation rate, serum C-reactive protein, coagulation factors, autoimmune markers, serology, electrocardiogram and carotid Doppler ultrasonography were completely normal. Brain MRI and MRA revealed recent vascular lesions in several vascular territories probably caused by an embolus. Transoesophageal echocardiography revealed an atrial septal aneurism (ASA) and a right to left shunt through a PFO. The patient started antiplatelet medication but there was no improvement in visual acuity.


An ASA is an infrequent finding in adult patients and in the majority of cases it is associated with other cardiac abnormalities such as PFO. PFO can be considered a normal variant, but it should be taken into account as a possible cause of recurrent or bilateral CRAO in patients who have no causative factors.

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