Central Retinal Artery Occlusion Associated with Atrial Septal Defect: A Case Report

  • Sharad Gupta Sagarmatha Choudhary Eye Hospital, Siraha, Lahan, Nepal https://orcid.org/0000-0001-8654-5172
  • Manoj Aryal Kathmandu Medical College Teaching Hospital
  • Yogita Rajbhandari Tilganga Institute of Ophthalmology, Kathmandu, Nepal
  • Ajay Adhikari National Academy of Medical Science (NAMS), Kathmandu, Nepal
  • Vinit Kumar Kamble Sagarmatha Choudhary Eye Hospital, Siraha, Lahan, Nepal
  • Binod Aryal Kathmandu Medical College Teaching Hospital
Keywords: Atrial Septal Defect, Central Retinal Artery Occlusion

Abstract

Introduction: Central retinal artery occlusion (CRAO) is characterized by sudden obstruction of the arterial blood flow in the retinal circulation with consequent ischemic damage to the retina resulting in vision loss. An interesting case of unilateral CRAO associated with atrial septal defect (ASD) in a young female is reported here. Case: A young female presented to emergency department with history of sudden and painless loss of vision in her right eye for one day. Her visual acuity at the time of presentation was perception of light in right eye and 6/6 in left eye. On examination, anterior segments of both the eyes were normal. However, relative afferent pupillary defect was positive in her right eye. On fundus examination, right eye showed pale retina and cherry red spot whereas left eye was unremarkable. Findings were suggestive of right eye CRAO. Ocular massage was done and oral carbonic anhydrase inhibitor was given. Patient was referred to a cardiologist for further evaluation and establishment of the etiology. All tests were within reference limit except a large ASD (secundum type with left to right shunt) with a diameter of 28 mm was revealed on transthoracic echocardiogram. Conclusion: The association between ASD and CRAO is rare. Intracardiac shunts through defect may predispose the disease. Detailed cardiac evaluation is mandatory to rule out possible causes to prevent ocular or systemic embolic events and associated morbidity.

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Author Biographies

Sharad Gupta, Sagarmatha Choudhary Eye Hospital, Siraha, Lahan, Nepal

Consultant Ophthalmologist

Manoj Aryal, Kathmandu Medical College Teaching Hospital

Optometrist,

Yogita Rajbhandari, Tilganga Institute of Ophthalmology, Kathmandu, Nepal

Consultant Ophthalmologist,

Ajay Adhikari, National Academy of Medical Science (NAMS), Kathmandu, Nepal

DM Resident, Department of Cardiology.

Vinit Kumar Kamble, Sagarmatha Choudhary Eye Hospital, Siraha, Lahan, Nepal

Consultant Ophthalmologist

 

Binod Aryal, Kathmandu Medical College Teaching Hospital

Medical Laboratory Technologist

References

Von Graefes A. Ueber Embolie der Arteria centralis retinae als Ursache plotzlicher Erblindung. Arch Ophthalmol. 1859; 5(1):136–157. DOI: https://doi.org/10.1007/BF02720764

Bull C, Deanfield J, de Leval M, Stark J, Taylor JF, Macartney FJ. Correction of isolated secundum atrial septal defect in infancy. Arch Dis Child. 1981; 56 (10):784–6. PMID: 7305418

Rigby ML. The era of transcatheter closure of atrial septal defects. Heart. 1999; 81 (3):227–8. DOI: http://dx.doi.org/10.1136/hrt.81.3.227

Sharma S, Sharma SM, Cruess AF, Brown GC. Transthoracic echocardiography in young patients with acute retinal arterial obstruction. RECO Study Group. Retinal Emboli of Cardiac Origin Group. Can J Ophthalmol 1997; 32 (1):38–4. PMID:9047032

Newsom RS, Trew DR, Leonard TJ. Bilateral buried optic nerve drusen presenting with central retinal artery occlusion at high altitude. Eye 1995; 9(Part 6): 806–808. PMID: 8849557. DOI :https://doi.org/10.1038/eye.1995.202

T. Nakagawa, A. Hirata, N. Inoue, Y. Hashimoto, and H. Tanihara. A case of bilateral central retinal artery obstruction with patent foramen ovale. Acta Ophthalmologica Scandinavica, 2004: 82(1); 111–112. PMID: 14738497

L. Clifford, R. Sievers, A. Salmon, and R. S. B. Newsom. Central retinal artery occlusion: association with patent foramen ovale. Eye, 2006; 20(6): 736–738. PMID: 6701983

Sunil V. Furtado, Prasanna K. Venkatesh, Ganesh K. Murthy, Arul D. Furtado, and Alangar S Hegde. Paradoxical Embolus across Atrial Septal Defect and Posterior Circulation Infarct in Neurosurgical Patients International Journal of Neuroscience. 2010; 120(7):516–520. PMID: 20583906. DOI: https://doi.org/10.3109/00207451003760072

Laskowski, I. A., Babu, S. C., Osinuga, Sr, O. A., Lessnau, K. D., & Menezes, N. S. (2018, October 02). Paradoxical Embolism. Retrieved October 24, 2018, from https://emedcine.medscape.com/article/460607-overview#a3t

Fathi, A. R., Eshtehardi, P., & Meier, B. Patent foramen ovale and neurosurgery in sitting position: A systematic review. British Journal of Anaesthesia, 2009; 102(5): 588–596. . PMID: 19346525. DOI : https://doi.org/10.1093/bja/aep063

Ozdemir, A. O., Tamayo, A., Munoz, C., Dias, B., & Spence, J. D. Cryptogenic stroke and patent foramen ovale: Clinical clues to paradoxical embolism Journal of Neurological Sciences. 2008; 275(1-2): 121–127. DOI : https://doi.org/10.1016/j.jns.2008.08.018

Published
2019-06-25
How to Cite
1.
Gupta S, Aryal M, Rajbhandari Y, Adhikari A, Kamble V, Aryal B. Central Retinal Artery Occlusion Associated with Atrial Septal Defect: A Case Report. J Lumbini Med Coll [Internet]. 25Jun.2019 [cited 6Jun.2020];7(1):34-6. Available from: https://jlmc.edu.np/index.php/JLMC/article/view/281
Section
Case Report