A branch retinal artery occlusion with symptomatic presentation led to the discovery of complete internal carotid artery occlusion, with subsequent MRI confirming acute ischaemic infarcts, highlighting retinal artery occlusion as a potential presenting sign of carotid artery disease.
A man in his late 60s presented with sudden-onset blurred vision in the right eye accompanied by systemic symptoms including pain, dizziness, sweating, and elevated blood pressure.
Ophthalmic examination revealed significantly decreased visual acuity in the right eye with retinal cholesterol emboli and ischaemic changes on fundoscopy.
Carotid duplex ultrasound indicated possible stenosis of the internal carotid artery, and subsequent MR angiography confirmed complete internal carotid artery occlusion.
Brain MRI performed two days after presentation revealed acute ischaemic infarcts in the right frontal and periventricular regions.
Branch retinal artery occlusion served as the presenting sign of an underlying complete internal carotid artery occlusion in this case.
This case report describes a man in his late 60s who went to the emergency room with sudden blurry vision in one eye, along with pain, dizziness, sweating, and high blood pressure. Eye examination showed very poor vision and signs of reduced blood flow to the retina (the light-sensitive tissue at the back of the eye), including cholesterol deposits that had broken off from elsewhere in the body and lodged in the eye's blood vessels. Initial ultrasound of the neck arteries suggested narrowing, but further imaging two days later revealed something more serious: the internal carotid artery — a major blood vessel supplying blood to the brain and eye — was completely blocked. A brain MRI also showed that small strokes had already occurred in two areas of the brain on the same side as the affected eye. This research suggests that what appears to be a localized eye problem (a branch retinal artery occlusion) can actually be a warning sign of a much more serious and life-threatening condition — complete blockage of a major neck artery. The cholesterol deposits seen in the eye's blood vessels were likely fragments that broke off from the blocked carotid artery and traveled to the eye, similar to how they can travel to the brain and cause strokes. The patient's previous stroke 20 years earlier and his risk factors (high blood pressure and high cholesterol) were consistent with progressive vascular disease. This case highlights that sudden vision loss should not be evaluated in isolation, as it can be the first visible indicator of significant vascular disease affecting the brain. Prompt and thorough vascular imaging, including of the neck arteries, appears to be critical when patients present with retinal artery blockages, especially when accompanied by additional symptoms. Early identification of carotid artery disease in such patients may allow for timely treatment to help prevent further strokes.
Karamitsou K, Magklaras E, Tsaousis K. (2026). Symptomatic branch retinal artery occlusion as a presenting sign of carotid artery occlusion.. BMJ case reports. https://doi.org/10.1136/bcr-2025-267059