A 65-year-old hypertensive diabetic presents with sudden painless loss of vision in the right eye. Fundus shows dilated tortuous veins, dot and blot hemorrhages in all four quadrants, disc edema, and cotton wool spots. The most likely diagnosis is:

• A Central retinal vein occlusion ✓
• B Central retinal artery occlusion
• C Hypertensive retinopathy grade IV
• D Proliferative diabetic retinopathy with vitreous hemorrhage

Explanation

Central retinal vein occlusion (CRVO) classically produces the 'stormy sunset' or 'blood and thunder' fundus—diffuse flame-shaped and dot-blot hemorrhages in all four quadrants, dilated and tortuous veins, disc edema, and cotton wool spots. Hypertension, diabetes, hyperlipidemia, and hypercoagulable states are risk factors. Central retinal artery occlusion causes a pale retina with a cherry-red spot and box-carring of vessels rather than hemorrhages.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.