Sudden Monocular Vision Loss in a Diabetic Patient — Likely Diagnosis and Management?

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This presentation is classic for central retinal artery occlusion (CRAO)—sudden, painless, severe vision loss with RAPD and the characteristic pale retina with a cherry-red spot on fundoscopy. The “curtain coming down” description can be seen, but the fundus findings strongly point toward CRAO rather than retinal detachment. CRAO is an ophthalmic emergency with a very narrow window for potential visual recovery (ideally within a few hours). Immediate measures aim to restore retinal perfusion, although evidence is limited. These include ocular massage, lowering intraocular pressure with topical agents/acetazolamide, and considering anterior chamber paracentesis in selected settings. Some centers may consider hyperbaric oxygen or thrombolysis in very early presentations. Equally important is the systemic workup, as CRAO is often embolic. The patient should be evaluated for carotid artery disease (Doppler), cardiac sources (ECG, echocardiography), and vascular risk factors such as diabetes, hypertension, and hyperlipidemia. It should be treated as a stroke equivalent, with urgent referral for stroke evaluation and secondary prevention. Prognosis is generally poor, especially if presentation is delayed beyond a few hours, as retinal ischemia rapidly leads to irreversible damage. Early recognition and immediate action are critical, even though visual outcomes remain limited in many cases.