<prompt> Cattle truck appearance on fundoscopyCentral serous retinopathyCoats diseaseCentral retinal artery occlusion CRAORetinopathy of prematurity ROP  <response>: Ans. c Central retinal artery occlusion Ref: Parsons 20lh302, A K Khurana 2nd26, 253CENTRAL RETINAL ARTERY OCCLUSION CRAO Etiologypathogenesis- There is usually an embolus or thrombus.- A yellow cholesterol embolus Hollenhorst plaque on the head of the optic nerve or in a branch of retinal artery confirms the diagnosis.- The most important causes of emboli are atherosclerotic plaques of the carotid arteries, arterial hypertension, and cardiac valve lesions. Epidemiology- The prevalence of CRAO is 0.85 per 100,000 population in one year.- It is a disease of adulthood in the sixth decade of life on average.- More common in males than in females. Involvement is bilateral in 1-2, with the exception of temporal arteritis and other systemic vasculitides. Clinical features- Patients present with sudden painless loss of vision.- Usually unilateral.- Direct pupillary light reflex is absent.- Retinal arteries are markedly narrowed.- Central part of mascular area shows cherry-red spot due to vascular choroid shining through thin retina.- Segmented blood column within retinal veins cattle- track appearance is pathognomonic of central retinal artery occlusion.- The arteries are thin and the segmented blood flow in the retinal arteries can be observed in acute stages of the disease. Diagnosis- Diagnosis is made clinically.- The diagnosis can be confirmed by fluorescence angiography. Differential diagnosis- Differentiation between arteritic Horton disease and nonarteritic CRAO is very important because in Horton disease the fellow eye can become involved within a few days without appropriate treatment. Treatment- There is no consensus currently about the efficacy of different forms of treatment.- Conservative treatment: globe massage, anterior chamber paracentesis, infusion treatment with pentoxifylline, hyperbaric oxygen, intravenous rTPA, or corticosteroid injection.- Invasive treatment: selective catheterization of the ophthalmic artery with administration of fibrinolytic drugs. Prognosis.- The visual acuity on first presentation generally decides the prognosis.- Spontaneous improvements are observed in up to 15.Various fundoscopic appearance Appearance on FundoscopyDiagnosis1Pinkish with central area of pallorNormal disc2HyperemiaPapilledema, papillitis3Pale discPartial optic atrophy4Chalky white discPrimary optic atrophy5Yellow waxy discConsecutive optic atroph6Shot-silk fundusPseudopapilitis7Champagne pale corkfundusChronic papilledema8Pale waxy disc with bone corpuscles like pigmentary changesRetinitis pigmentosa9Cattle truck appearance of retinal veinsCRAO10Ink-blot Enlarging dot pattern Smoke stake patternCentral serous retinopathy11Flower petal appearanceCystoid macular edema12Cotton woolspotsMost common abnormality in AIDS13Tomato sauce and cheese OR Crumbled cheese and Ketchup OR Brush-fire OR Pizza pie appearanceCMV retinitis14.Angioid streaks Pseudoxanthoma elasticum Pagets disease of bone, Ehler Danlos disease Sickle cell disease.15.Bulls eye maculopathyChloroquine16.Severe retinal telangiectesiaCoats disease17.Salt and pepper fundus Congenital rubella, syphilis, HSV, Varicella, mumps Lebers amaurosis Mayous-Batten disease Thioridazine toxicity Cancer associated retinopathy Carriers of Choroideremia, albinism, Retininitis Pigmentosa.18.Sea Fan RetinaSickle cell disease19.Candle waxappearanceSarcoid retinopathy20.Cherry Red spotsMnemonic: Pick My QT Bags Niemann-Picks disease Multiple sulfatase deficiency Quinine amblyopia TaySachs disease Berlins edema Commontio retinae due to blunt trauma CRAO Gauchers disease Sandhoff disease Sialidosis type 1 and 221.Cherry red spotsNOT seen in CRVOIn CRVO, Rubeosis iridis develops in about 50 of eyes, usually in 3 months 100-day glaucoma, and there is a high risk of neovascular glaucoma. 