Unilateral retinopathy in a patient with diabetes and coronary heart disease

A 69 year old man with type 2 diabetes mellitus, obesity, hypertension, and coronary artery disease was referred for diabetic retinopathy screening. He was also undergoing evaluation for transient ischaemic attack after experiencing dizziness and intermittent weakness in the left hand over the past six months. Visual acuities and intra-ocular pressures were normal, and slit lamp examination of the anterior segment of both eyes was unremarkable. Funduscopic examination (figs 1, 2) and wide field fluorescein angiography (fig 3) revealed unilateral retinopathy in the left eye. These unilateral findings prompted concern for carotid disease. Doppler carotid ultrasonography (fig 4) and computed tomography angiography found complete occlusion of the left internal carotid artery. Fig 1 Ultrawide field …