Two Strokes in One Patient: An Interesting Case Report

Central retinal arterial occlusion (CRAO) causes a sudden and devastating visual loss. Transient blurring of vision may precede CRAO and is often ignored by the patient, as it may resolve spontaneously without permanent visual loss. However, this can be a warning sign of ischaemia, particularly in individuals with multiple risk factors. We report a case of a 50-year-old man with CRAO in his left eye. The patient had a history of transient blurring of vision in the same eye 15 days prior, which resolved without intervention. He also had a history of stroke 12 years ago and had been on anticoagulants but discontinued them three years before this episode. This, combined with chronic smoking and poorly controlled diabetes mellitus, likely contributed to a hypercoagulable state, leading to thrombus formation responsible for CRAO. Fundus examination revealed an opaque and oedematous macula with a cherry red spot and blurred optic disc margins. Treatment with ocular massage and paracentesis improved the patient's vision to finger counting at 2 m. The patient was started on aspirin and advised of strict blood sugar control. This case highlights the importance of recognising transient ischaemic symptoms and maintaining long-term anticoagulant therapy to prevent severe complications like CRAO.