Acute unilateral vision loss from central retinal artery occlusion associated with an atrial septal aneurysm and a patent foramen ovale: a case report.

Abstract

BACKGROUND: Acute unilateral vision loss is an ophthalmological emergency. It can have multiple aetiologies, and physicians must be able to quickly determine the cause of the condition, as immediate intervention may prevent permanent vision loss. Acute unilateral vision loss has not previously been associated with a patent foramen ovale (PFO). OBJECTIVE: We describe a patient who presented with painless sudden loss of vision in his left eye. He was diagnosed to have central retinal artery occlusion, likely from a paradoxical embolus associated with an atrial septal aneurysm containing a PFO. The patient underwent successful percutaneous closure of the PFO without complication. This report details the evaluation and differential diagnosis of acute unilateral vision loss. Additionally, the controversy of whether a PFO should be closed prophylactically for stroke prevention is discussed. CONCLUSION: Acute unilateral vision loss from central retinal artery occlusion may be caused by a paradoxical embolus originating from an atrial septal aneurysm with a PFO. This case should be considered in the controversy of whether prophylactic closure of a PFO could be beneficial for primary prevention of stroke.