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13>A 60-year-old man suddenly becomes completely blind in one eye, and
angiography demonstrates occlusion of the central retinal artery.
Which of the following is the most likely cause of the occlusion?
A. Atheroma or embolism
B. Cranial (temporal) arteritis
C. Hypertension
D. Polycythemia vera
E. Tumor
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That's right
13>The correct answer is A. The point of this question is that sometimes the obvious explanation is the correct one. Occlusion of the central retinal artery rapidly causes irreversible blindness with loss of the inner retinal layers. (The photoreceptor rod and cone cells are maintained by the pigment epithelium.) The site of occlusion is typically just posterior to the cribriform plate. A garden-variety atheroma or embolism is overwhelmingly the most common cause of central retinal artery occlusion.
Despite all of the teaching about the risk of blindness in temporal arteritis (choice B), this disorder causes only 10% of central retinal artery occlusions.
Hypertension (choice C) is more apt to cause bleeding than thrombosis.
Polycythemia vera (choice D) could (rarely) cause occlusion because of increased blood viscosity and a tendency for thrombosis.
Tumor (choice E) might also cause retinal artery thrombosis, but this would be far rarer than atheroma
