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Central Retinal Artery Occlusion

No clinical trials have demonstrated improvement with any treatment compared with observation1 and historically CRAO has an abysmal prognosis. Despite the unlikely chance of improvement, maneuvers are usually attempted if a patient presents within 24 hours...

As CRAO is a vaso-occlusive phenomenon, there is a great deal of interest in the use of tPA in its treatment. While there are published reports of vision improvement after the administration of tPA,13 there is debate about whether or not this improvement is greater than the natural history of CRAO...

Recently, the undersea and hyperbaric medicine society made a recommendation for the consideration of hyperbaric oxygen…

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 Early Identification of Central Retinal Artery Occlusion Using Point-of-care Ultrasound

On arrival to the tertiary care center, the ED team performed a POCUS, linear probe, 12 MegaHertz (MHz) of the patient’s eye to evaluate for retinal detachment. No evidence of retinal detachment, vitreous detachment, or massive vitreous hemorrhage was found. However, the study demonstrated a widened and irregular optic nerve sheath, which measured over the normal limit of five millimeters (mm).5 Additionally, an area of hyperechoic signal was noted in the distal aspect of the optic nerve, raising concern for embolic event

Articles of Interest

Central Retinal Artery Occlusion: Can We Effectively Manage This Ocular Emergency in a Hospital Setting?

Central retinal artery occlusion (CRAO) is an ophthalmological emergency characterized by partial or complete occlusion of the central retinal artery. It is the ocular equivalent of an ischemic cerebral stroke. Patients frequently present with a significant, abrupt, painless loss of vision in one eye, with only around 20% of those affected getting functional visual acuity restored in the affected eye. Despite more than 150 years of clinical research, no consensus has been achieved regarding the most effective method of treating CRAO.

Central Retinal Artery Occlusion: General Overview, Diagnosis, and Treatment

Central retinal artery occlusion (CRAO), or a stroke of the eye, is an ocular emergency. It represents end-organ ischemia and is analogous to terminal branch occlusion in cerebral stroke.

Hyperbaric Treatment Of Central Retinal Artery Occlusion

If the onset of symptoms is within 24 hours of presentation, and the patient has no response to normobaric hyperoxia after 15 minutes, refer for emergency hyperbaric medicine consultation.

Management of Central Retinal Artery Occlusion...

There is no compelling evidence that conservative treatments for CRAO are effective, and trends in the observational literature suggest that ocular massage, anterior chamber paracentesis, and hemodilution may be harmful.

A review of central retinal artery occlusion: clinical presentation and management

CRAO should be considered as an ocular emergency and is the ocular analogue of cerebral stroke. The same atherosclerotic risk factors that predispose to cardio, peripheral, and cerebrovascular disease are present in CRAO, and these must be actively evaluated to prevent further medical comorbidities. Effective treatment of CRAO must target acute reperfusion of the CRA...

Central Retinal Artery Occlusion – Clinical Pathway

Emergency department management of stroke includes utilizing imaging appropriately based on the type of stroke, assessing patient risk for additional cardiovascular or stroke events, and recognizing subtle or different forms of stroke, such as patients who have normal initial imaging or patients who present with a central retinal artery occlusion.

Central retinal artery occlusion – rethinking retinal survival time

Complete CRAO of more than 12–15 min duration is likely to be sufficient to cause stroke of the retinal ganglion cells which form the optic nerve. This may be one reason why no strong evidence based therapy exists for CRAO. If multiple serial fundus examinations show no retinal arterial flow as evidenced by segmentation and stagnation of the arterial blood columns for more than about 15′, treatment is likely to be futile.

Hyperbaric Oxygen Therapy for Central Retinal Artery Occlusion: Patient Selection and Perspectives

It is difficult to perform large-scale randomized controlled trials for CRAO since it happens at such a low frequency when compared to other ischemic episodes, which makes it challenging to find a cure. In the limited randomized controlled trials that have been published, it has been proved that no proven intervention is more effective than doing nothing. Prospective trials with well-designed study designs are still required in order to find the most effective treatment for CRAO.

Is It Too Late to Treat?

The diagnosis in this case is ophthalmic artery occlusion in the patient’s right eye. The ophthalmologic management for retinal and ophthalmic vein occlusion must take place within 70 minutes to offer hope of visual recovery.

Resources

EyeRounds.org

The patient’s classic description of painless, sudden loss of vision one day prior to presentation, and the appearance of the "cherry-red spot" on fundus examination made the diagnosis of a central retinal artery occlusion (CRAO). Acutely can perform ocular-digital massage +/- anterior chamber paracentesis +/- give oral medications to lower intraocular pressure such as acetazolamide. Carbogen therapy, which is a carbon dioxide and oxygen combination, has been thought to help dilate vasculature and is used by some institutions. Hyperbaric oxygen therapy has also been described as a possible intervention.

EyeWiki

Sudden vision loss in a patient older than 50 years of age should immediately raise suspicion for Giant Cell Arteritis. Urgent systemic steroids may be needed to preserve vision in the affected eye and prevent vision loss in the unaffected eye (PPP strong recommendation).

StatPearls

CRAO typically presents with sudden, painless, monocular vision loss that occurs over seconds. Patients may report an antecedent transient visual loss (amaurosis fugax) and often have a history of atherosclerotic disease.