BACKGROUND: Central retinal artery occlusion (CRAO) is an ophthalmic emergency and a retinal ischemic stroke. Cilioretinal arteries may remain perfused during CRAO because they arise from the posterior ciliary circulation. Most reported cilioretinal sparing involves papillomacular or foveal preservation; nasal sparing is atypical. We report CRAO with nasal retinal sparing and spontaneous head-turn behavior during screening.

CASE REPORT: A 55-year-old man presented with a 2-day history of sudden, painless vision loss in the right eye. He had newly diagnosed hypertension and was an active smoker. Visual acuity was 1/200 in the right eye and 20/20 in the left. During emergency-room screening, he spontaneously turned his head left while attempting to read a tumbling-E chart. Examination showed a right relative afferent pupillary defect. Fundus examination revealed a cherry-red spot, diffuse retinal whitening, and a nasally preserved sector. Fluorescein angiography confirmed nasal perfusion from a patent nasal cilioretinal artery. Nasal optical coherence tomography (OCT) showed preserved retinal architecture, whereas vertical macular OCT showed inner retinal thickening and hyperreflectivity. Bedside confrontation testing suggested gross temporal field preservation.

CONCLUSIONS: Multimodal imaging documented atypical nasal retinal sparing in acute CRAO. Because the nasal retina subserves the temporal visual field, the leftward head turn was anatomically compatible with possible compensatory eccentric viewing toward residual temporal field function. However, formal perimetry was unavailable, and this observation remains hypothesis-generating rather than diagnostic. Correlating patient behavior with multimodal imaging may help localize residual retinal function while reinforcing the need for urgent systemic vascular evaluation.

Keywords: Fluorescein Angiography, Retinal Artery Occlusion, Tomography, Optical Coherence