title: Embolic Central Retinal Artery Occlusion Detected with Point-of-care Ultrasonography in the Emergency Department.
abstract: BACKGROUND
  Ocular emergencies account for 2-3% of all emergency department (ED) visits. Sonographic evaluation of the eye offers a very useful diagnostic tool in the ED. In the ED setting, ocular ultrasound could identify a retinal detachment, or a massive vitreous hemorrhage, and the training for emergency medicine practitioners is quite easy.
  
  
  METHODS
  An 84-year-old woman presented to our ED with a painless acute vision loss in her right eye. Immediate bedside emergency ocular ultrasound was performed, and it showed a retrobulbar hyperechoic material, suggestive of an embolus within the central retinal artery. Fluorescein angiography showed limited and sluggish filling of the retinal arteries after injection of fluorescein, and optical coherence tomography demonstrated a decrease in the reflectivity and thickness of the inner retinal layers. The final diagnosis was embolic central retinal artery occlusion (CRAO). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Among the causes of acute loss of vision, CRAO is associated with systemic vascular disease. The importance of visible retinal emboli has been well documented due to its association with increase in mortality. A rapid evaluation of the central retinal artery could be a simple tool to identify an embolus, and this could lead to a rapid treatment. The evaluation of central retinal artery is a less defined setting in emergency physician bedside ultrasound, but the identification of CRAO could lead to a rapid acceleration in diagnosis and treatment of a potentially life-threatening disease.
authors.affiliation: SC Medicina e Chirurgia d'Accettazione e d'Urgenza-OBI, Ospedale San Paolo, Savona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Riccardi
authors.affiliation: SC Oculistica, Ospedale San Paolo, Savona, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Siniscalchi
authors.affiliation: SC Medicina e Chirurgia d'Accettazione e d'Urgenza-OBI, Ospedale San Paolo, Savona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lerza
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D019095:Point-of-Care Systems; D015356:Retinal Artery Occlusion / Q000000981:diagnostic imaging*; D041623:Tomography, Optical Coherence; D014463:Ultrasonography / Q000379:methods*
keywords: central retinal artery occlusion; emergency ultrasound; sudden vision loss