Which fundus finding is characteristic of central retinal artery occlusion?

• A. Cherry-red spot.
• B. Cotton-wool patches.
• C. Neovascularization.
• D. Vessel tortuosity.

Answer: (A)

In central retinal artery occlusion, sudden loss of blood flow to the inner retina causes acute retinal ischemia, so the retina becomes visibly pale and edematous. The fovea, however, is relatively spared because the outer retina there is nourished by the choroidal circulation rather than the retinal arteries. This contrast between the pale, ischemic surrounding retina and the normal-appearing fovea creates the cherry-red spot, which is the most characteristic and recognized fundus finding in this condition.

Cotton-wool patches are more typical of microvascular nerve fiber layer infarcts seen in disorders like diabetic or hypertensive retinopathy. Neovascularization indicates chronic, ongoing ischemia with new vessel growth, not the acute picture of CRAO. Vessel tortuosity can occur with chronic vascular changes but is not specific to acute retinal arterial occlusion.