Retinal Artery Occlusion

  • General Information:
    • Considered to be a form of a stroke with similar clinical approach and management
    • Incidence is low with less than 10 in 100,00
    • Average age is 60-65 with men more commonly affected and RF of HTN, smoking and diabetes
    • Most common etiology is carotid artery atherosclerosis, especially in older patients. Other etiologies common in the elderly include cardioembolic disease, carotid artery dissections, hypercoagulable states and vascultitis
  • Clinical Manifestations:
    • Central retinal artery occlusion and branch retinal artery occlusion present with acute, painless loss of monocular vision
    • Central retinal artery occlusion: acute and profound loss of vision in one eye, often painless, can be preceded by transient monocular blindness or a stuttering, fluctutaing course
    • Branch retinal artery occlusion: acute monocular vision loss that may be restricted to part of the visual field, with less than half of patients having impaired visual acuity
  • Diagnosis:
    • On funduscopic exam with CRAO you will see a “cherry red spot” in the macula with ischemic retinal whitening due to the occlusion +/- retinal emboli.
    • For BRAO there is a sectoral pattern to the retinal opacification +/- retinal emboli.
    • Definitive diagnosis is rarely needed, but can be confirmed with fluorescein angiography
  • Treatment: OCULAR EMERGENCY
    • Can attempt occular massage, anterior chamber paracentesis, mannitol or acetazolamide can reduce IOP, vasodilator medications or hyperbaric oxygen
    • In selected patients, ophtho can do intra-arterial thrombolysis or surgical revascularization