Calcific retinal embolism as an indicator of severe unrecognised cardiovascular disease

Objective: To describe the association between calcific retinal embolism (CRE) and cardiac valve stenosis. Design and setting: Retrospective chart review of patients with clinical criteria for CRE. Patients: 24 patients with CRE who underwent two dimensional echocardiography between 1976 and 1998. Results: Nine patients (38%) had calcific valve stenosis, which was haemodynamically severe in five patients (four aortic and one mitral), four of whom had no cardiac symptoms. Six patients underwent surgical intervention (aortic valve replacement in three patients, mitral and aortic valve replacement in one patient, removal of calcific cardiac pseudotumour in one patient, and carotid endarterectomy in one patient). Conclusions: CRE may be the presenting feature of otherwise asymptomatic, clinically important underlying cardiovascular disease and, in particular, haemodynamically severe calcific valve stenosis.