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Central retinal artery occlusion (CRAO) presents with acute, unilateral, painless vision loss.^1-3 Visual deficits from CRAO can be permanent or transient, as in amaurosis fugax.¹ Risk factors include older age (>60 years), male gender, carotid disease, atrial fibrillation, hypercoagulable states, and cardiovascular risk factors like obesity, hypertension, smoking, and dyslipidemia.^1,2 The incidence is 1.9/100,000 people.^1,2 The pathogenesis is embolic, thrombogenic or vasculitic.¹ Examination reveals an afferent pupillary defect with cherry red spot on fundoscopy.^1,2 Differential diagnoses include anterior ischemic optic neuropathy and retinal vein occlusion.² Timely intervention with tissue plasminogen activator may be beneficial, though this treatment is considered controversial with conflicting results and potential risk of intraparenchymal brain hemorrhage.^1-3 Hyperbaric oxygen has also shown mixed results, but high-dose steroids may be useful in cases caused by a vasculitic etiology.^1-3 Prognosis is typically poor for full visual recovery.¹

References:

1. Mac Grory B, Schrag M, Biousse V, et al. Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Hypertension; and Council on Peripheral Vascular Disease. Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association. Stroke. 2021;52(6):e282-e294; doi:10.1161/STR.0000000000000366. Erratum in: Stroke. 2021;52(6):e309.

2. Farris W, Waymack JR. Central Retinal Artery Occlusion. StatPearls [Internet]. Updated September 11, 2021. https://www.statpearls.com/ArticleLibrary/viewarticle/19136

3. Chan W, Flowers AM, Meyer BI, Bruce BB, Newman NJ, Biousse V. Acute Central Retinal Artery Occlusion Seen within 24 Hours at a Tertiary Institution. J Stroke Cerebrovasc Dis. 2021;30(9):105988; doi:10.1016/j.jstrokecerebrovasdis.2021.105988

Submitted by: Neha Sharma, MD, Research Fellow, Houston Medical Clerkship and Faisal Khan MD, DABSM, DABPN, Consultant Neurologist, Sugarland Neurology and Sleep

Dr. Sharma and Dr. Khan report no disclosures.