A 45-year-old woman presents with a sudden scotoma in her left eye. Fundoscopy reveals a whitish-grey area at the posterior pole with a cherry-red spot. There is no afferent pupillary defect. The most likely pathology and the preferred time window for intervention with ocular massage/anterior chamber paracentesis is:
- A Central retinal vein occlusion; intervention within 24 hours
- B Branch retinal artery occlusion; intervention within 4 hours
- C Central retinal artery occlusion; intervention within 90 minutes ✓
- D Acute ischemic optic neuropathy; intervention within 6 hours
Correct answer: C. Central retinal artery occlusion; intervention within 90 minutes
Explanation
The presentation — sudden painless visual loss, whitish retinal edema at posterior pole with cherry-red spot at the fovea (perfused by choroidal circulation via cilioretinal artery or direct choroidal supply) — is classic for central retinal artery occlusion (CRAO). The inner retina tolerates ischemia for approximately 90-100 minutes; interventions (ocular massage, AC paracentesis, IOP-lowering) aimed at dislodging an embolus must be attempted within this window. Beyond this, irreversible ganglion cell death occurs.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.