From the Guidelines
The most common cause of central retinal (ophthalmic) artery thrombosis is atherosclerosis, particularly carotid stenosis, which is discovered in up to 70% of patients with symptomatic central retinal artery occlusion (CRAO) 1.
Key Points
- Atherosclerosis is the primary cause of central retinal artery thrombosis, leading to turbulent blood flow, endothelial damage, and subsequent thrombus formation.
- Risk factors that significantly contribute to CRAO include hypertension, diabetes mellitus, hyperlipidemia, advanced age, and hypercoagulable states.
- Patients with CRAO typically present with sudden, painless vision loss in one eye, and may have a relative afferent pupillary defect and characteristic funduscopic findings.
- Management focuses on treating underlying risk factors, controlling intraocular pressure, and addressing complications such as macular edema with intravitreal anti-VEGF injections or steroids.
- Early diagnosis and treatment are essential to prevent permanent vision loss, and patients with acute retinal artery occlusion (RAO) should be referred immediately to an emergency department or stroke center facility for neurological evaluation due to the increased risk of central nervous system stroke 1.
Clinical Considerations
- The use of hyperbaric oxygen therapy has demonstrated efficacy in several small randomized trials, but its role in the management of CRAO is still limited 1.
- Panretinal photocoagulation (PRP) with or without anti-vascular endothelial growth factor (anti-VEGF) therapy is recommended for patients who develop iris or retinal neovascularization 1.
- Antiplatelet and statin therapies will apply to the vast majority of affected patients, while carotid surgery will apply to less than 30% of patients 1.
From the Research
Causes of Central Retinal Artery Thrombosis
There are no research papers provided that directly answer the question about the most common cause of central retinal (ophthalmic) artery thrombosis. However, some studies discuss the causes of central retinal vein occlusion, which may be related.
Related Causes of Central Retinal Vein Occlusion
- Predisposing factors such as hypertension, diabetes, atherosclerosis, and hypercoagulable states have been described as potential causes of central retinal vein occlusion 2, 3.
- Local ophthalmic illnesses such as open angle glaucoma, ocular trauma, and orbital infections have also been suggested as causative factors 2.
- Disordered blood rheology, changes in the local hemostatic potential, and impaired blood stream in the corresponding retinal vein branches have been identified as major factors contributing to the pathogenesis of central retinal vein thrombosis 4.