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Central Retinal Artery Occlusion
This is usually due to emboli arising in the carotid artery, intracranially or from the heart. A quarter of eyes have collateral arteries serving the macular retina so that central vision can be retained to some extent.
Incidence
Is a common cause of blindness in the elderly. Majority of patients are >60 years. Younger patients usually have valvular heart disease.
Risk factors
Symptoms
- Painless, almost instantaneous loss of vision in one eye.
- In 90% of cases visual acuity ranges from counting fingers to light perception.
- May have been earlier transient visual loss (amaurosis fugax).
Signs
- Afferent pupillary defect can appear an hour before abnormality of the fundus, immediately after occlusion.
- Opacified superficial retina, except cherry-red spot in the foveola (choroid or retinal pigment epithelium seen through very thin overlying foveola retina).
- Retinal opacification resolves within 4-6 weeks leaving pale optic disc.

- Fluorescein angiography
- Carotid Doppler ultrasound to detect occlusion even in absence of bruit
- Investigate other risk factors for atherosclerosis.
- Optical Coherence Tomography. (This is an interferometric, non-invasive optical imaging technique first demonstrated in 1991. It produces a cross-sectional image of tissue.1 Central retinal artery occlusion has a distinct pattern,2 which may distinguish cases that are equivocal on clinical findings.
Non-drug
- Firm ocular massage may dislodge embolus, or contact lens may be used
- Anterior chamber paracentesis
- Isovolaemic haemodilution
- Reduction of arterial hypertension
Drug
Anticoagulants
Document references
- The New York Eye and Ear Infirmary. Ocular Imaging Center Optical Coherence Tomography (OCT) Clinical Database. Website with normal and pathological images.
- Falkenberry SM, Ip MS, Blodi BA, et al; Optical coherence tomography findings in central retinal artery occlusion. Ophthalmic Surg Lasers Imaging. 2006 Nov-Dec;37(6):502-5. [abstract]
- Schmidt DP, Schulte-Monting J, Schumacher M; Prognosis of central retinal artery occlusion: local intraarterial fibrinolysis versus conservative treatment. AJNR Am J Neuroradiol. 2002 Sep;23(8):1301-7. [abstract]
- Feltgen N, Neubauer A, Jurklies B, et al; Multicenter study of the European Assessment Group for Lysis in the Eye (EAGLE) for the treatment of central retinal artery occlusion: design issues and implications. EAGLE Study report no. 1 : EAGLE Study report no. 1. Graefes Arch Clin Exp Ophthalmol. 2006 Aug;244(8):950-6. Epub 2005 Dec 22. [abstract]
- Arashvand K. Central Retinal Artery Occusion. NEJM. ( Good images); February 2007
- Graham RH, Huang E. Central Retinal Artery Occlusion. e-Medicine; January 2007
DocID: 1922
Document Version: 21
DocRef: bgp861
Last Updated: 8 Nov 2007
Review Date: 7 Nov 2009
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