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October 2007

Bilateral Orbital Infarction, Ophthalmic Artery Occlusion, and Cherry-red Spot

Arch Ophthalmol. 2007;125(10):1441. doi:10.1001/archopht.125.10.1441-a

In the March 2007 issue of the Archives, Maier et al1 described a case of bilateral orbital infarction syndrome due to ophthalmic artery occlusion following craniotomy.

Ophthalmic artery occlusion produces profound vision loss (light perception or no light perception) due to the simultaneous ischemia of the choroid and retina. A cherry-red spot can be an acute initial sign but is more suggestive of central retinal artery occlusion. In previously reported series of orbital infarction, profound vision loss was seen in all of the cases, including those with a cherry-red spot.2,3 Close serial examination allowed the investigators to note the “disappearance of the cherry-red spot, suggesting choroidal ischemia.”2 Maier and associates did not provide such follow-up information, and more importantly, their patient did not have profound vision loss.