Case presentation:
A 62-year-old man with a past medical history of type 2 diabetes mellitus, hypertension and diabetic nephropathy under hemodialysis, referred to the emergency department of Valiasr hospital, Tehran, Iran on April, 29, 2021. He presented with shortness of breath and hypoxia. He had two histories of surgery, coronary artery bypass grafting (CABG) and cataract surgery for both eyes. On admission, his vital signs showed a temperature of 37.3°C, heart rate of 100, respiratory rate of 24, blood pressure of 117/63 mm Hg and pulse oximetry of 60%. Moreover, crackle sounds were heard when he was breathing. Upon examination, he was diagnosed with acute respiratory distress syndrome (ARDS), so he was admitted to intensive care unit (ICU) and stayed there for 10 days. On day 8 of hospitalization, the patient complained of a headache and pain in the right eye followed by a more severe headache and edema in the right eye the next day.
On day 10 of hospitalization, his health condition exacerbated. He had vision loss on the right eye and proptosis in both eyes. In eye examination chemosis, conjunctivitis and cherry red spot in the right eye were seen, which represented central retinal artery occlusion (CRAO).
He was transferred to ophthalmology center (Rasoul Akram hospital) for endoscopic surgical debridement. Unfortunately, he expired on hospital day 30.