Central Retinal Artery Occlusion: Early Diagnosis With Advanced Ultrasound Transorbital Doppler Imaging

A 62-year-old man presented with sudden, painless, complete vision loss in left eye upon nocturnal awakening. Ophthalmoscopy revealed pale retina and cherry-red spot, suggestive of central retinal artery occlusion (CRA-O). Brain CT-angiography was normal, and left internal carotid artery ultrasound examination showed <50% calcific stenosis (Figure 1A). Macular optic coherence tomography was consistent with suspicion (Figure 1B). Transorbital Doppler sonography (TDS) performed at presentation revealed a hyperechoic spot sign posterior to the optic nerve head, representing a CRA distal fibrocalcific thrombus (Figure 2, Video 1).1 No Power-Doppler spectral signal from CRA was detectable (Figures 1, C–D and 2B–D; Video 1).