Delhi Journal of Ophthalmology

Symmetrical Hollenhorst Emboli with Branch Retinal Artery Occlusion

Sanjay Kumar Mishra, Ashok Kumar
Army College of Medical Sciences & Base Hospital Delhi Cantt, New Delhi, India

Editor-in-Chief, Delhi Journal of Ophthalmology, Dr R.P.Centre, AIIMS.

Corresponding Author:

Ashok Kumar
Army College of Medical Sciences & Base Hospital Delhi Cantt, New Delhi - 110010, India
Email id:

Received: 12-JUL-2019 Accepted: 08-AUG-2019 Published Online: 27-FEB-2020

Purpose: To report a rare phenomenon of symmetrical hollenhorst emboli with branch retinal artery occlusion in a middle aged male with sub-optimal visual recovery.
Case Description: A 50 year old man with a history of being known case of diabetes mellitus since 07 years presented to the ophthalmic emergency with sudden, profound diminution of vision in right eye of 05 days duration. His best corrected visual acuity (BCVA) was 20/400 in right eye and 20/30 in left eye. Fundus examination of right eye revealed normal optic disc with two symmetrical yellowish, refractile cholesterol emboli (Hollenhorst plaques) in supero-tempora and inferotemporal branch of retinal artery. Emboli in supero-temporal retinal had lead to obstruction of artery with pale retina in its distribution and superior part of macula. Immediate treatment with tab acetazolamide 500mg stat, ocular massage alonwith paracentesis was done with no improvement in vision. Cardiology consultation revealed cardiac emboli on trans-esophageal echocardiography but normal carotid Doppler. Patient was treated with anticoagulant, antiplatelet therapy with no evidence of adverse cardiac or neurological event on follow-up for next 02 months with some improvement in BCVA to 20/200. 
Conclusion: Symmetrical hollenhorst emboli leading to BRAO is a rare phenomenon which requires immediate ophthalmological as well as cardiology management for preventing ocular morbidity as well as mortality in these patients. 

Keywords :Hollenhorst emboli; Branch retinal artery occlusion; Anticoagulant therapy

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