Sudden Visual Shadow in a 70-Year-Old Man

A 70-year-old man complained of shadow vision in one eye since the morning. He was concerned about a possible retinal detachment. Fundoscopy revealed occlusion of the superior temporal artery by a cholesterol embolus and resulting ischemic edema of the affected areas of the retina. The main causes of retinal artery occlusion are atherosclerosis-associated thrombosis, embolism from the carotid circulation, giant-cell arteritis, and embolism from the heart. After evaluation for risk factors, this patient was given rheologic treatment. The source of his embolism was identified as atherosclerotic plaques in the internal carotid artery. A vascular surgical intervention was not indicated. He was treated over the long term with ASA 100 mg/day. The sudden appearance of a shadow in the visual field is always an indication for an emergency ophthalmologic examination.

Fundoscopy reveals a yellow cholesterol embolus (arrow) and a resulting area of ischemia