Central retinal artery occlusion

Central Retinal Artery Occlusion

File:Central retinal artery occlusion.jpg

Central retinal artery occlusion as seen in fundoscopy

The Central Retinal Artery Occlusion (CRAO) is a medical condition that occurs when the central retinal artery - the main artery that supplies blood to the inner retinal layers - becomes blocked. This blockage typically results from a thrombus or embolus, leading to sudden, painless, and usually severe loss of vision in one eye.

Etiology

The most common cause of CRAO is an embolus from the carotid artery or the heart. Other causes include giant cell arteritis, collagen vascular disease, hypercoagulable states, and migraine.

Pathophysiology

When the central retinal artery becomes occluded, the inner layers of the retina lose their blood supply. This leads to ischemia and infarction of the retina, resulting in sudden vision loss.

Clinical Presentation

Patients with CRAO typically present with sudden, painless, monocular vision loss. The extent of vision loss can range from a small scotoma to complete blindness. On fundoscopy, the retina appears pale with a characteristic "cherry-red spot" at the fovea.

Diagnosis

Diagnosis of CRAO is primarily clinical, based on the patient's history and fundoscopic examination. Additional tests such as fluorescein angiography, optical coherence tomography, and carotid ultrasound may be used to confirm the diagnosis and identify the source of the embolus.

Treatment

Treatment of CRAO is aimed at restoring blood flow to the retina as quickly as possible to minimize permanent damage. This may involve ocular massage, lowering intraocular pressure, or systemic thrombolysis. However, the effectiveness of these treatments is uncertain, and there is currently no universally accepted treatment protocol for CRAO.

Prognosis

The prognosis for visual recovery in CRAO is generally poor, with most patients experiencing permanent vision loss. The extent of visual loss and the potential for recovery depend on the duration and severity of the occlusion.

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