Treatment of Central Retinal Artery Occlusion

Abstract

Central retinal artery occlusion (CRAO) is the ocular equivalent of an acute cerebral ischemic event. It is most commonly caused by an embolus from the ipsilateral carotid artery, aortic arch or heart, leading to partial or complete occlusion of the central retinal artery. Patients with a CRAO need a thorough stroke evaluation to search for the cause of the embolus, since the risk factors for a CRAO are very similar, if not identical, to the risk factors for stroke. In addition, since about 20% of patients with a CRAO have concurrent acute cerebral ischemia, an emergent brain MRI is necessary, even in the absence of neurologic symptoms. To date, there are no therapeutic interventions that have shown improved visual outcomes compared to the natural history of CRAO. Therefore, management of an acute CRAO is focused on secondary prevention and minimizing the risk of subsequent ischemic events, such as myocardial infarction, cerebral ischemia, and cardiovascular death.