Pre-papillary arterial loop in ocular hypertension: a rare association.

Pre-papillary vascular loop (PVL) is a rare congenital retinal vascular anomaly, often underdiagnosed due to its asymptomatic nature. Originating from retinal arteries or veins, PVL may lead to complications such as branch retinal artery occlusion (BRAO). This case report describes a man in his 60s presenting with sudden-onset vision loss in the left eye, diagnosed with BRAO secondary to a pre-papillary arterial loop, alongside ocular hypertension and their management. Differentiating BRAO-induced retinal nerve fibre layer (RNFL) defects from glaucomatous changes was challenging due to overlapping clinical and visual field findings. This case highlights the diagnostic complexity of PVL, particularly in distinguishing it from early glaucoma. Meticulous evaluation is crucial to avoid misdiagnosis and ensure appropriate management in such rare presentations.