Combined Central Retinal Vein and Cilioretinal Artery Occlusion: A Case Report and Review

Introduction Combined central retinal vein occlusions and cilioretinal artery occlusions are rare conditions typically seen in patients with underlying systemic diseases. Although the pathophysiology remains unclear, a thorough systemic workup must be completed because of retinal arterial involvement. Patients must be monitored closely to detect and manage complications that may arise from the vein and/or artery occlusion. Case Report A 42-year-old male patient presented with sudden-onset decreased vision in the left eye. The patient had a systemic diagnosis of pulmonary embolism and was recently switched from warfarin to a novel oral anticoagulant, apixaban. The patient’s vision in the left eye was reduced, with dilated fundus examination revealing a combined cilioretinal artery and central retinal vein occlusion. The patient was subsequently treated with intravitreal bevacizumab injections. Echocardiogram and carotid Doppler revealed reduced left ventricular performance and a probable thrombus. The hematologist discontinued apixaban and restarted warfarin. Conclusion Effective comanagement between eyecare providers and other health care communities, such as hematology and cardiology, is essential to ensure patients are thoroughly evaluated and managed to prevent not only vision loss but also death. Although novel oral anticoagulants require less monitoring and more convenient dosing, they may not be the optimal first-line treatment in certain patients. Patients need to be educated on the risks, complications, and contraindications associated with these medications, as well as the need for strict follow-up. Although combined cilioretinal artery and central retinal vein occlusions are rare, optometrists must be aware of associated complications. A thorough systemic workup should be completed to rule out life-threatening causative conditions.