Central retinal artery occlusion

Central retinal artery occlusion (CRAO), also known as retinal stroke, is an ophthalmic emergency in which the central retinal artery — the main blood vessel supplying the inner layers of the retina — becomes blocked, most commonly by an embolus or thrombus. This sudden interruption of blood flow leads to ischemia of the retinal tissue, resulting in acute, painless, and typically profound loss of vision in the affected eye. On fundoscopic examination, the retina appears pale and edematous with a characteristic "cherry-red spot" at the macula, where the underlying choroidal circulation is visible through the thin foveal tissue. CRAO predominantly affects the visual system but is considered a marker of systemic vascular disease, as it shares risk factors with stroke and cardiovascular events, including atherosclerosis, hypertension, diabetes mellitus, hyperlipidemia, cardiac valvular disease, and hypercoagulable states. CRAO most commonly occurs in older adults, typically in the sixth to seventh decade of life, and is slightly more prevalent in males. The condition is usually unilateral. Visual prognosis is generally poor, with most patients retaining only limited peripheral vision or light perception. Rarely, patients with a cilioretinal artery (a variant blood supply from the choroidal circulation) may preserve some central vision. There is no universally proven treatment, though acute interventions attempted within hours of onset include ocular massage, anterior chamber paracentesis, intravenous or intra-arterial thrombolysis, and reduction of intraocular pressure with medications such as timolol or acetazolamide. Hyperbaric oxygen therapy has also been explored. Importantly, patients diagnosed with CRAO require urgent systemic workup — including carotid imaging, echocardiography, and cardiac rhythm monitoring — to identify and manage underlying vascular risk factors and reduce the risk of subsequent stroke or myocardial infarction.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

Common questions about Central retinal artery occlusion