Case Report: Retinal Artery Occlusion Associated with Patent Foramen Ovale

Introduction Patent foramen ovale, an atrial septal opening that fails to close after birth, occurs in one-fourth of the general population and is often asymptomatic. However, patent foramen ovale does have a known multifactorial association with stroke and retinal ischemia and needs to be considered as a potential etiology in unexplained cases of permanent or transient instances of such ischemia. Case Report A 54-year-old woman presented urgently with sudden central vision loss in the left eye. Visual acuity was 20/50, visual fields demonstrated central and cecocentral defects, and there was a 1.2 log unit relative afferent pupillary defect in the left eye. Retinal pallor in the area of the papillomacular bundle with a “cherry-red” appearance of the fovea, as well as optical coherence tomography evidence of inner retina hyper-reflectivity, paracentral acute middle maculopathy, and a prominent middle limiting membrane, all confirmed a left retinal artery occlusion. She had no stroke risk factors, and immediate work-up uncovered a patent foramen ovale as a potential cause of her acute ischemia. Conclusion Any form of permanent or transient acute retinal ischemia is considered a stroke-like episode necessitating urgent referral to a stroke center or a rapid access transient ischemic attack clinic. A patent foramen ovale should be considered as a potential etiology of ischemic stroke or any retinal artery occlusion in cases in which the event cannot be explained by any other probable cause. Prompt identification and management of patent foramen ovale, potentially including percutaneous closure, is important to reduce recurrent stroke risk.