Central Retinal Artery Occlusion

Central Retinal Artery Occlusion is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • 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”

Etiology

  • 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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Basics

Description

  • 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”

Etiology

  • 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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