October 2018 Image of the Month

Image of the Month, a recurring feature in Retinal Physician since 2006, spotlights diagnostic images captured by industry practitioners using innovative technology and diagnostic instruments.

Central Retinal Artery Occlusion Following Crack-Cocaine Usage



A 56-year-old female with a history of hypertension and known drug abuse presented with light perception vision with a two-day history of sudden painless loss of vision in the right-eye. Upon further question, the patient admitted to smoking crackcocaine previous to her vision loss. Her past ocular history was unremarkable. SLO-color photography was performed (Optos PLC, Edinburgh, Scotland, United Kingdom) which demonstrated unilateral right-sided macular hyper-reflectivity with a bright red fovea centralis (“cherry-red spot”) consistent of a central retinal artery occlusion (CRAO) (Figure 1A). In addition, Swept-Source Optical Coherence Tomography (SS-OCT) (Topcon Triton; Tokyo, Japan) revealed whitening of both the inner and outer retinal layers with a relatively normal appearing ellipsoid zone (EZ) & retinal pigmented epithelium (RPE). (Figure 1B). Patient drug toxicology report confirmed cocaine usage. An anterior chamber tap was performed without any subsequent improvement in vision.

The opinions, ideas, views and assumptions expressed are the author's own and do not necessarily represent the views of Topcon, nor do they constitute advice from Topcon.

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