Differential Diagnosis for CRAO
Single most likely diagnosis
- Central Retinal Artery Occlusion (CRAO): This is the most likely diagnosis given the physical exam findings in the ER, which directly suggest CRAO. CRAO is a condition where the central retinal artery becomes blocked, leading to sudden and severe vision loss in one eye.
Other Likely diagnoses
- Branch Retinal Artery Occlusion (BRAO): Similar to CRAO but involves the blockage of one of the branches of the retinal artery, leading to vision loss in a portion of the visual field.
- Ocular Ischemic Syndrome: A condition caused by severe carotid artery stenosis or occlusion, leading to reduced blood flow to the eye and potentially causing vision loss.
- Retinal Vein Occlusion: Although more commonly associated with vein occlusion, it can sometimes present with similar symptoms and should be considered in the differential diagnosis.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Giant Cell Arteritis: A condition that can cause CRAO and is a medical emergency. It requires immediate treatment with corticosteroids to prevent further vision loss and other complications.
- Carotid Artery Dissection: A tear in the carotid artery wall can lead to reduced blood flow to the eye and brain, potentially causing a stroke. Prompt diagnosis and treatment are crucial.
- Migraine: Although typically not as severe, certain types of migraines can cause transient vision loss and should be considered, especially if other symptoms like headache are present.
Rare diagnoses
- Talc Embolism: Rarely, intravenous drug users can experience talc embolism, which can lead to retinal artery occlusion.
- Susac Syndrome: A rare condition characterized by microangiopathic changes in the brain and retina, leading to vision loss among other symptoms.
- Eale Disease: A rare disease that affects the retinal blood vessels, potentially causing retinal artery occlusion, especially in young adults.