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Retinal Artery Occlusion After a Dog Bite in a 55-Year-Old Man

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 55-year-old man was referred to the eye clinic for unilateral uveitis and 2 days of sudden vision loss in his right eye. He reported experiencing light sensitivity and mild eye pain. He was in otherwise good health without any chronic medical problems. He reported receiving anticoagulation therapy in the past for a mitral valve problem. His visual acuity was 20/200 OD and 20/20 OS. The examination of the left eye was unremarkable. Slitlamp examination of his right eye revealed 3+ anterior chamber inflammation with vitreous cells. An examination of the dilated fundus showed optic nerve edema with an overlying white infiltrate. In addition, there was inferior retinal whitening consistent with an artery occlusion (Figure 1A). The whitening was attributable to inner retina ischemia, with sparing in the distribution of the cilioretinal artery. An inferior hemicentral retinal artery occlusion was confirmed on intravenous fluorescein angiography (Figure 1B). No embolus was noted at any retinal artery branch points. Notably, a dog bit the patient’s hand 2 months before presentation. Since that time, the patient developed a persistent cough, night sweats, and low-grade fevers that were treated unsuccessfully with 2 courses of oral antibiotics.

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A 55-year-old man was referred to the eye clinic for unilateral uveitis and 2 days of sudden vision loss in his right eye. He reported experiencing light sensitivity and mild eye pain. He was in otherwise good health without any chronic medical problems. He reported receiving anticoagulation therapy in the past for a mitral valve problem. His visual acuity was 20/200 OD and 20/20 OS. The examination of the left eye was unremarkable. Slitlamp examination of his right eye revealed 3+ anterior chamber inflammation with vitreous cells. An examination of the dilated fundus showed optic nerve edema with an overlying white infiltrate. In addition, there was inferior retinal whitening consistent with an artery occlusion (Figure 1A). The whitening was attributable to inner retina ischemia, with sparing in the distribution of the cilioretinal artery. An inferior hemicentral retinal artery occlusion was confirmed on intravenous fluorescein angiography (Figure 1B). No embolus was noted at any retinal artery branch points. Notably, a dog bit the patient’s hand 2 months before presentation. Since that time, the patient developed a persistent cough, night sweats, and low-grade fevers that were treated unsuccessfully with 2 courses of oral antibiotics.

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Article Information

Corresponding Author: Shriji N. Patel, MD, Department of Ophthalmology, Vanderbilt University School of Medicine, 2311 Pierce Ave, Nashville, TN 37232 (shriji.patel@vumc.org).

Published Online: May 6, 2021. doi:10.1001/jamaophthalmol.2020.5282

Conflict of Interest Disclosures: Dr Patel reported receiving research grant support from Alcon outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
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Jenkins  TL , Talcott  KE , Matsunaga  DR ,  et al.  Endogenous bacterial endophthalmitis: a five-year retrospective review at a tertiary care academic center.   Ocul Immunol Inflamm. 2020;28(6):975-983. doi:10.1080/09273948.2019.1642497PubMedGoogle ScholarCrossref
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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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