Abstract

A 70-year-old-man presented following the subacute onset of loss of vision in his right eye. In the previous weeks he had also experienced a dull ache around the right eye (ocular angina) and dimming of his vision in the right eye when out in sunlight, which was slow to recover. He was a smoker and taking medication for hypertension and diabetes.

Examination revealed:

• episcleral vascular congestion and neovascularization of the iris of the right eye (Fig. 1);

• reduced visual acuity in the right eye to light perception only;

• a mid-dilated right pupil and right relative afferent pupillary defect;

• fundosopic appearances of severe retinal ischaemia, similar to those of central retinal artery occlusion (Fig. 2); there was no evidence of venous stasis retinopathy, which is characterized by dilated veins and dot and blot haemorrhages and microaneurysms in the deeper layers of the mid peripheral retina (and can