Central Retinal Artery Occlusion


  • Condition causing impaired blood flow to the retina
  • Essentially vascular disease of the eye
  • Ophthalmic emergency- although outcomes are generally poor

Risk Factors

  • Hypertension (up to 66%)
  • Diabetes mellitus
  • Valvular disease/PFO (cardiac embolus)
  • Hypercholesterolaemia (carotid artery disease)
  • Giant cell arteritis (inflammation)


  • Acute, persistent, and usually profound painless visual loss.  This may come on like ‘a curtain drop’ but more often than not is just sudden.
  • Common signs of a CRAO are a relative afferent pupil defect.
  • On fundoscopy, there is a pale retina (loss of arterial blood and build up of oedema), with thread-like retinal vessels.
    • There may also be a classical ‘cherry red spot’ (this is actually choroidal vessels that are seen through the thin and now pale macula where the retina is thinnest).


  • Giant cell arteritis should be excluded by investigating plasma viscosity and ESR.
  • If the patient presents within 24 hours with CRAO, ocular massage may help (only to dislodge an embolus to cause a branch retinal artery inclusion instead).
  • Carotid doppler should also be used to investigate carotid disease.
  • Medication may be required to reduced the IOP which can build up due to oedema secondary to the blockage.
    • CA inhibitors (azetazolomide), beta-blockers
  • Outcome is often poor

Amaurosis fugax

This is a temporary retinal artery occlusion causing a temporary complete loss of vision.  This is commonly due to an embolus that has been dislodged or inflammatory spasm that has resolved.

Branch Retinal Artery Occlusion

  • As above but one branch of the retinal artery affected
  • Typically presents with visual field loss (depending on the branch)

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: