Cardiogenic Embolism and the Eye

When transient monocular blindness (TMB), branch retinal artery occlusion (BRAO), central retinal artery occlusion (CRAO), and retinal emboli are discussed, the primary consideration is carotid atherosclerotic disease or, in some cases of CRAO, local small vessel atherosclerotic disease. Until relatively recently, cardiogenic embolism was considered an uncommon cause of ischemic stroke. More recent clinical and pathological studies indicate that 15% to 20% of ail ischemic strokes are cardioembolic (1, 2). Among younger patients with ischemic stroke, a cardioembolic origin accounts for an even larger proportion (2). While anacdotal reports provide ample evidence that emboli originating in the heart affect the eye, it is not clear from available studies how often symptomatic ocular ischemia (transient monocular blindness, retinal artery occlusion, and ischemic optic neuropathy) is the resu It of cardioembolism or what the risk of ocular stroke is in various individual cardiac conditions prone to produce emboli. umerous cardiac conditions produce embolism (Table 1) and are diagnosed by transthoracic or transesophageal echocardiography (Table 2).