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JAMA Ophthalmology Clinical Challenge
May 6, 2021

Retinal Artery Occlusion After a Dog Bite in a 55-Year-Old Man

Author Affiliations
  • 1Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
JAMA Ophthalmol. Published online May 6, 2021. doi:10.1001/jamaophthalmol.2020.5282

A 55-year-old man was referred to the eye clinic for unilateral uveitis and 2 days of sudden vision loss in his right eye. He reported experiencing light sensitivity and mild eye pain. He was in otherwise good health without any chronic medical problems. He reported receiving anticoagulation therapy in the past for a mitral valve problem. His visual acuity was 20/200 OD and 20/20 OS. The examination of the left eye was unremarkable. Slitlamp examination of his right eye revealed 3+ anterior chamber inflammation with vitreous cells. An examination of the dilated fundus showed optic nerve edema with an overlying white infiltrate. In addition, there was inferior retinal whitening consistent with an artery occlusion (Figure 1A). The whitening was attributable to inner retina ischemia, with sparing in the distribution of the cilioretinal artery. An inferior hemicentral retinal artery occlusion was confirmed on intravenous fluorescein angiography (Figure 1B). No embolus was noted at any retinal artery branch points. Notably, a dog bit the patient’s hand 2 months before presentation. Since that time, the patient developed a persistent cough, night sweats, and low-grade fevers that were treated unsuccessfully with 2 courses of oral antibiotics.

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