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Correspondence: Paul Varner John J Pershing VAMC, 1500 N Westwood Boulevard, Poplar Bluff, MO 63901, USA Tel +1 573 778 4303 Fax +1 573 778 4164 Email paul.varner@va.gov Abstract: Retinal cholesterol emboli (RCE) are occasionally found on ophthalmic examination. Originally, all RCE were thought to be related to impending cardiovascular morbidity and mortality, but it is now apparent that accompanying symptoms can be used to help better stratify cardiovascular event risk for these patients. Regardless of associated visual symptoms, all patients with RCE but unknown medical status, merit referral to primary care providers for further assessment of cardiovascular health status. Symptomatic patients with known cardiovascular diseases require carotid duplex ultrasonography to determine degree of arteriolar occlusion with possible referral to vascular surgeons for invasive correction of carotid artery occlusive disease. Asymptomatic patients with known cardiovascular profiles may benefit from the addition of only 81 mg aspirin if not otherwise contraindicated. Screening carotid studies should not be considered for these patients. Carotid auscultation in the eye clinic setting is unwarranted for either set of patients.

The clinical import of a retinal cholesterol embolus: it is a question of symptoms