From the Guidelines
Central retinal artery occlusion (CRAO) presents with sudden, painless, severe vision loss in one eye, typically described as a dramatic drop in vision to counting fingers or worse, often within seconds to minutes 1. The symptoms of CRAO are characterized by a sudden and painless decrease in visual acuity and field of vision in one eye, which can occur over a period of seconds 1. Patients may experience a range of visual acuity, from mild impairment to complete blindness, and may or may not have visible fundus abnormalities.
- Key symptoms of CRAO include:
- Sudden and painless vision loss in one eye
- Decrease in visual acuity and field of vision
- Possible presence of a cherry-red spot in the fovea due to the contrast between the choroidal circulation and the ischemic retina
- Relative afferent pupillary defect (RAPD)
- Narrowed retinal arteries, segmentation of blood columns ("boxcarring"), and retinal edema
- It is essential to note that CRAO is considered an ocular emergency requiring immediate medical attention, as treatment within 4-6 hours offers the best chance of salvaging vision 1. The condition often indicates underlying systemic vascular disease, as it commonly results from emboli from carotid artery disease or cardiac sources, or from inflammatory conditions like giant cell arteritis, particularly in older patients 1.
From the Research
Central Retinal Artery Occlusion Symptoms
- Sudden, painless vision loss is a common symptom of central retinal artery occlusion (CRAO) 2
- Blurred vision, worse during hypertensive episodes, may also be experienced by patients with CRAO 3
- Central retinal artery occlusion has a very poor visual prognosis, and the use of thrombolytics remains controversial 4
Treatment Options
- Various "conservative" pharmacologic treatments, such as pentoxifylline, isosorbide dinitrate, and acetazolamide, have been proposed as potential treatments for CRAO 4
- Nonpharmacologic approaches, including carbogen, hyperbaric oxygen, ocular massage, anterior chamber paracentesis, laser embolectomy, and hemodilution, have also been suggested 4
- Thrombolytic therapy has been suggested as a viable therapy for CRAO, but its effectiveness has yet to be validated through randomized controlled studies 5
- Combined intravenous acetazolamide and ocular massage may be effective in treating central retinal artery thromboembolism when delivered promptly 3