Background: Central retinal artery occlusion is a rare but a severe ophthalmic emergency leading to permanent vision loss in most patients. It was identified over 160 years ago but effective treatment remains to be discovered. 

Case report: A 77-year-old Caucasian American male presented to urgent care clinic with sudden loss of vision OS after a prolong coughing episode due to pulmonary fibrosis. After evaluation for stroke, he was sent to the eye clinic for further ocular examination. He was diagnosed with comorbid CRAO and extensive retinal detachment OS. Subsequently, he was seen by a local retinal specialist who sent him to a local hospital emergency department for a more extensive stroke work up. After two-day of hospital stay, he was discharged in a stable condition and to continue care with primary care provider, retinal specialist, pulmonologist and cardiologist. 

Conclusion: Although it is rare to encounter ocular emergencies in the eye clinic, but it can be in your chair; sometimes, two urgent conditions can show up simultaneously. Therefore, optometrists should be prepared with a handy reference on what to do, and which team to activate to achieve optimal co-management to preserve vision and save life.