PANCE Blueprint EENT (7%)

Patient will present as → an 82-year-old man presents to the emergency department complaining of vision loss in his left eye. He states that it suddenly appeared as if a curtain was coming down over his left eye. It resolved after five minutes, and his vision has returned to normal. He has a history of coronary artery disease and type 2 diabetes.

Transient partial or complete loss of vision in one eye - The most common cause of amaurosis fugax is a cholesterol plaque emboli from a carotid artery plaque

• Blockage of the central retinal artery leads to sudden, painless, monocular vision loss due to retinal hypoxia
• Vision loss is classically described as a curtain coming down over one eye
• Amaurosis fugax (an example of a TIA) occurs if the clot passes and the vision loss is transient. If the clot cannot pass, central retinal artery occlusion occurs

A fundus exam may reveal optic disk pallor, a cherry-red macula, and retinal edema

If it does not resolve spontaneously, treatment is recommended within an hour of the occlusion

• Treatment involves surgical decompression, but, if unavailable, digital massage of the globe and CO2 rebreathing should be initiated in an attempt to pass the clot