From the Guidelines
Yes, a patent foramen ovale (PFO) can potentially cause a retinal artery clot. A PFO is a small opening between the two upper chambers of the heart that normally closes after birth but remains open in about 25% of adults. This opening can allow small blood clots to bypass the lungs (where they would typically be filtered out) and travel directly from the right to the left side of the heart, entering the arterial circulation. These clots can then travel to various parts of the body, including the retinal artery, causing a blockage known as a retinal artery occlusion. This mechanism is called paradoxical embolism.
Key Points to Consider
- Patients with unexplained retinal artery occlusion, especially younger individuals without traditional cardiovascular risk factors, should be evaluated for a PFO 1.
- Diagnosis typically involves echocardiography with bubble study.
- If a PFO is found to be the likely cause of a retinal artery clot, treatment options may include antiplatelet therapy (such as aspirin 81-325 mg daily), anticoagulation (like warfarin with target INR 2-3, or direct oral anticoagulants), or in some cases, PFO closure via a minimally invasive procedure 1.
- The choice of treatment depends on individual patient factors and should be determined through consultation with both cardiology and ophthalmology specialists.
Treatment Considerations
- For carefully-selected patients with a recent ischemic stroke or TIA attributed to a PFO, PFO device closure plus long-term antiplatelet therapy is recommended over long-term antithrombotic therapy alone, provided certain criteria are met 1.
- Antiplatelet therapy is recommended over no therapy for adult patients with cryptogenic stroke and a PFO, with no other risk factors 1.
- The use of antiplatelet agents over anticoagulation with warfarin is reasonable for adult patients with cryptogenic stroke and a PFO, with no other risk factors 1.
Important Considerations for Patient Care
- Patients presenting with a central retinal artery occlusion (CRAO) typically describe a sudden, painless decrease in visual acuity and field of vision in one eye that occurs over a period of seconds 1.
- The incidence of CRAO likely increases with age, and the mean age at presentation in the United States is the early 60s 1.
- A CRAO commonly leads to retinal ischemia and subsequent retinal cell death, making prompt evaluation and treatment crucial 1.
From the Research
Patent Foramen Ovale and Retinal Artery Clot
- There is no direct evidence in the provided studies that links a patent foramen ovale (PFO) to a retinal artery clot.
- However, the studies suggest that PFO can be a risk factor for ischemic strokes of undetermined cause (cryptogenic strokes) 2.
- The mechanism of stroke in patients with PFO is thought to be related to the paradoxical embolism, where a blood clot forms in the venous system, passes through the PFO, and lodges in an arterial vessel, potentially causing a stroke 3, 4, 5, 6.
- It is possible that a similar mechanism could contribute to the formation of a retinal artery clot, but this is not explicitly stated in the provided studies.
- The studies focus on the relationship between PFO and stroke, as well as the efficacy of PFO closure, antiplatelet therapy, and anticoagulation in preventing recurrent stroke 3, 4, 5, 6.
- Further research would be needed to determine if there is a link between PFO and retinal artery clot.