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

TOPCON

BACKGROUND

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.

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