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A 75-year-old man with hypertension presented to the emergency department complaining of sudden right eye visual field loss. His right visual acuity was 20/60. Fundus examination revealed multiple intravascular yellow-white plaques (Hollenhorst plaques; arrows) and pale retina (Figure A ). Optical coherence tomography showed inner retinal edema in the involved area (Figure B). A diagnosis of branch retinal arterial occlusion was made. Tracking back his systemic history, he had internal carotid arterial occlusion 4 years ago. Since then, he has been taking low-dose daily aspirin to prevent heart attacks and strokes. One year later, his visual acuity was 20/50 and the pale retina resolved with multiple residual intra-arterial plaques (Figure C). Optical coherence tomography showed nerve fiber layer thinning superior to fovea (Figure D).
Branch retinal arterial occlusion stems from the obstruction of a branch of the central retinal artery and results in focal ischemia of the wedge-shaped area. A critical aspect of managing patients with branch retinal arterial occlusion is to assess their risk of stroke such as with carotid ultrasound and echocardiography as needed.
Potential Competing Interests: The author reports no competing interests.