A young patient presented with sudden painless loss of vision with systolic murmur over chest, ocular examination reveals – cherry red spot in macula with clear AC, with perception of light, diagnosis:
**Core Concept**
Central retinal artery occlusion (CRAO) is a sudden and painless loss of vision caused by the blockage of the central retinal artery, which supplies blood to the retina. This condition often presents with a characteristic "cherry red spot" in the macula due to the relative preservation of the retinal pigment epithelium.
**Why the Correct Answer is Right**
The patient's symptoms of sudden painless loss of vision, coupled with a systolic murmur, suggest a possible embolic event. In CRAO, the blockage of the central retinal artery leads to ischemia of the retina, resulting in a sudden loss of vision. The presence of a cherry red spot in the macula is a classic sign of CRAO, as the macula receives blood from both the retinal and choroidal circulations, allowing it to appear relatively preserved. The clear anterior chamber (AC) and perception of light suggest a severe ischemic event.
**Why Each Wrong Option is Incorrect**
**Option A:** Central retinal vein occlusion typically presents with retinal hemorrhages and edema, not a cherry red spot.
**Option B:** Central retinal vein occlusion often has retinal hemorrhages and edema, and vision loss is typically more gradual.
**Option C:** Macular choroiditis with infective endocarditis might present with uveitis, retinal vasculitis, and vision loss, but the cherry red spot is not a characteristic finding.
**Option D:** Central serous retinopathy typically presents with a localized area of retinal detachment and vision loss, often with a more gradual onset.
**Clinical Pearl / High-Yield Fact**
CRAO is a medical emergency that requires prompt treatment, often with thrombolysis or anticoagulation to restore blood flow to the retina.
**✓ Correct Answer: A. Central retinal artery occlusion**