Cilioretinal Artery Occlusion Associated with Progressive Optic Nerve Head Ischemic Involvement: A Case Report

Cilioretinal artery occlusion is an uncommon retinal vascular emergency that can cause acute monocular visual loss, particularly when the macular region is involved. Non-arteritic anterior ischemic optic neuropathy is another ischemic disorder involving the optic nerve head and is usually associated with optic disc edema and sudden painless visual impairment. Although both conditions involve vascular territories related to the posterior ciliary circulation, the temporal and pathophysiological relationship between cilioretinal artery occlusion and optic nerve head ischemia remains incompletely defined. This case describes a 62-year-old woman with poorly controlled type 2 diabetes mellitus who presented with acute painless visual loss in the right eye. Initial fundus examination showed optic disc pallor and edema, grayish-white retinal edema extending from the optic disc to the macular region, macular involvement, and arterial attenuation. Multimodal ophthalmic evaluation, including fundus photography, Humphrey visual field testing, optical coherence tomography, visual evoked potential testing, and fundus fluorescein angiography, supported a diagnosis of cilioretinal artery occlusion with concurrent and progressive optic nerve head ischemic involvement, clinically consistent with suspected non-arteritic anterior ischemic optic neuropathy. Because the time window for thrombolysis had passed, conservative management for retinal arterial occlusion was initiated. After progression of optic disc edema and angiographic evidence of optic nerve head leakage, parabulbar triamcinolone was administered after consideration of systemic steroid-related risks. Partial reduction of optic disc edema and limited visual improvement were observed during follow-up; however, the single-case design and concurrent treatments preclude any conclusion regarding treatment efficacy. This case emphasizes that optic disc changes in cilioretinal artery occlusion should be monitored dynamically and interpreted using multimodal imaging rather than assumed to represent a fixed sequential diagnostic pattern.