Central retinal artery occlusion associated with patent foramen ovale: a case report and literature review

Patent foramen ovale might cause cryptogenic strokes, including retinal artery occlusion. Herein, we describe a previously healthy young man who presented with central retinal artery occlusion in the setting of patent foramen ovale and explore the need for transesophageal echocardiogram for its diagnosis. Cardiovascular workup and neuroimaging were unremarkable. Transthoracic echocardiogram bubble study revealed a right to left atrial shunt and subsequent transesophageal echocardiogram disclosed patent foramen ovale. This congenital cardiac anomaly was the likely conduit for a thrombo-embolic central retinal artery occlusion. We identified seven patients with patent foramen ovale associated with central retinal artery occlusion in the literature. Transthoracic echocardiogram was diagnostic in only one patient (14.3%), whereas transesophageal echocardiogram was required to reveal patent foramen ovale in the remaining six (85.7%). Our case and the previous reports support the link between central retinal artery occlusion and patent foramen ovale. Therefore, providers should consider the more sensitive transesophageal echocardiogram during the initial evaluation of young patients without immediately identifiable causes of retinal artery occlusion.

Automated summary

This case report highlights the association between patent foramen ovale and central retinal artery occlusion, emphasizing the importance of transesophageal echocardiogram in diagnosis. The study found that transthoracic echocardiogram was diagnostic in only one patient, while transesophageal echocardiogram was required in the remaining six cases. This suggests that providers should consider using transesophageal echocardiogram for a more sensitive evaluation in young patients with retinal artery occlusion.