Continued Lodging of Retinal Emboli in a Patient with Internal Carotid Artery and Ophthalmic Artery Occlusions

Internal carotid artery or ophthalmic artery occlusions are devastating ophthalmological events which lead to severe impairment of vision. A case of multiple branch retinal artery occlusions in a 63-year-old male with internal carotid artery and ophthalmic artery occlusions on brain angiography is presented. Emboli lodging in branches of the retinal arteries were bright, glistening, yellow or orange in appearance. Such a distinctive ophthalmoscopic appearance led to the diagnosis of cholesterol emboli. Fluorescein and indocyanine green angiography disclosed delayed filling of the retinal vessels and choroid, and showed multiple hypofluorescence distal to the vessels in which the emboli were lodged. At the time of initial examination, the number of emboli lodged in retinal arteries was estimated at more than 20. As time passed, a few of the previous emboli disappeared and new emboli appeared in other sites on fundus examination. We think that the lodging of new emboli in other sites is due to the continued break-up of atheromatous tissue through the collateral circulation associated with the occlusion of the internal carotid and ophthalmic arteries.