In central retinal artery occlusion (CRAO), the characteristic fundus finding that helps distinguish it from other causes of sudden painless visual loss is:

• A Disc oedema with peripapillary haemorrhages in a flame pattern
• B Scattered dot and blot haemorrhages in all four quadrants
• C Vitreous haemorrhage obscuring the fundus details
• D Diffuse retinal whitening (oedema) with a cherry-red spot at the fovea ✓

Explanation

CRAO causes ischaemic retinal whitening from inner retinal oedema (cytotoxic oedema of the inner retinal layers which receive blood from the central retinal artery). The fovea appears as a cherry-red spot because the thin foveal retina (lacking ganglion cell and inner nuclear layers) is transparent, allowing the underlying choroidal circulation (supplying the outer retina and choriocapillaris) to be seen through — appearing red against the surrounding white ischaemic retina. Peripapillary flame haemorrhages with disc oedema are characteristic of CRVO. Scattered haemorrhages in all quadrants are features of CRVO. Vitreous haemorrhage may indicate PDR or ruptured macroaneurysm.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.