Central Retinal Artery Occlusion

Basics

Obstruction of the central retinal artery associated with sudden painless loss of vision
Usually occurs in persons 50–70 yr of age
Ophthalmic artery is the first branch of carotid
Risk factors include HTN, atherosclerotic disease, sickle cell disease, vasculitis, valvular heart disease, lupus, trauma, and coronary artery disease
Incidence of 1–10/100,000
Often described as a “stroke of the eye”

Embolic:
- Occlusion by intravascular material from a proximal source:
  - Atherosclerotic disease (majority)
  - Carotid artery stenosis
  - Valvular heart disease (cardiogenic emboli)
  - Atrial myxoma
  - Dissection of the ophthalmic artery
  - Carotid artery dissection
Thrombotic:
- Obstruction of flow from the rupture of a pre-existing intravascular atherosclerotic plaque
- Hypercoagulable states (sickle cell)
Inflammatory:
- Due to giant cell arteritis, temporal arteritis, lupus, vasculitis
Arterial spasm:
- Associated with migraine headaches
Decreased perfusion:
- Low-flow conditions such as in severe hypotension or high-pressure situations seen in acute angle-closure glaucoma or retrobulbar hemorrhage

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