SUDDEN MONOCULAR VISION LOSS AFTER SNEEZING AS CAPTURED ON WIDEFIELD SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY-ANGIOGRAPHY.

Abstract

Purpose: We report an unusual case of likely combined retinal artery occlusion and retinal vein occlusion after a sneeze. Widefield swept-source optical coherence tomography-angiography was used to analyze retinal changes at one-month follow-up.

Methods: The patient reported visual symptoms in his left eye immediately after sneezing five times in a row. Fundus examination showed an embolus along the superior arcade. Stroke workup revealed moderate carotid artery stenosis and a subtherapeutic INR. At one-month follow-up, fundus photography and swept-source optical coherence tomography-angiography were obtained.

Results: Fundus photography showed superior retinal whitening and arteriole attenuation, an inferior perifoveal cotton wool spot, and inferotemporal intraretinal hemorrhages. Swept-source optical coherence tomography-angiography showed loss of the deep capillary plexus superiorly and inferotemporally, most consistent with combined retinal artery and retinal vein occlusion.

Conclusion: We report the first case of sneeze-induced combined retinal artery and retinal vein occlusion. The retina is a uniquely accessible window that provides insight into human physiology, and swept-source optical coherence tomography-angiography is a powerful tool that can give further insight into the pathophysiology of an occlusion.