A 68-year-old male with a history of hypertension and atrial fibrillation presents to the emergency department complaining of a sudden, painless, and profound loss of vision in his right eye that began one hour ago. Which of the following is the most likely diagnosis?
Acute angle-closure glaucoma
Vitreous hemorrhage
Retinal detachment
Retinal artery occlusion
Central retinal artery occlusion (CRAO) is an ophthalmologic emergency characterized by the sudden, painless, and severe loss of vision in one eye. It is often caused by an embolus from sources like the carotid arteries or the heart, which is why a history of atrial fibrillation is a significant risk factor. Retinal detachment typically presents with floaters, flashing lights (photopsia), and a curtain-like field defect. Acute angle-closure glaucoma is associated with severe eye pain, a fixed mid-dilated pupil, headache, and nausea. Vitreous hemorrhage can also cause sudden, painless vision loss, but it is often described as involving floaters, cobwebs, or a haze rather than a complete loss of vision.
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