Should be screened as an emergency by ophthalmology first for other causes. Retinal artery occlusion is usually an embolic phenomenon.
About
- May be due arteritis i.e. temporal arteritis
- Other causes are atherosclerosis/embolism
Aetiology
- Embolism from carotid artery or aortic plaque or heart
- Vasculitis e.g. GCA
Risks
- Older age, Male gender, Smoking
- Hypertension, Obesity, Diabetes
- Hyperlipidemia, Cardiovascular disease
- Thrombophilia, Arrhythmias
Clinical
- Painless monocular loss of vision
- May be transient or may persist
- Look for a carotid bruit, AF, murmurs, risk factors
- Pale Ischaemic Retina with cherry red spot
Pale Ischaemic Retina with cherry red spot
Differentials
- Temporal artertitis
- Central retinal vein occlusion
- Retinal detachment
- Migrainous aura
Investigations
- FBC, ESR, ECG, U&E, Glucose, Lipids
- Carotid ultrasound and Cardiac echo
- MRI if concerns of cerebral embolism
Management
- Visual loss with CRAO is usually severe, and is strongly correlated with the amount of retinal oedema
- Ocular massage, Acetazolamide, Hyperbaric oxygen, anterior chamber paracentesis, Nitroglycerin all of questionable efficacy
- Consider thrombolysis if persisting visual loss < 4.5 hours but controversial and clinical trial needed
- Manage vascular risks : Aspirin 300 mg OD stat then 75-300 mg OD or Clopidogrel 300 mg stat then 75 mg od, Atorvastatin 20-40 mg OD
- Carotid endarterectomy if ipsilateral stenosis > 50% and low peri-operative risk
- Anticoagulation for AF should be considered
References