Emergency: requires immediate attention
Central retinal artery occlusion - External and Internal Eye
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Synopsis

Central retinal artery occlusion (CRAO) is an uncommon condition that can cause sudden, irreversible, severe unilateral vision loss. It usually occurs in individuals over the age of 65 and accounts for 1 in 10,000 outpatient ophthalmology visits.
With acute blockage of blood flow through the central retinal artery, profound vision loss ensues. A patient typically presents with sudden unilateral painless vision loss. There may be a history of amaurosis fugax in 10% of patients.
Embolism is the most common cause of CRAO, usually originating from the carotid arteries or the heart. Other causes include inflammation (including giant cell arteritis), vessel spasm, thrombosis, hypercoagulable state, hypertensive retinal necrosis, increased intraocular pressure, hemorrhage under an atherosclerotic plaque, and dissecting aneurysm within the central retinal artery.
Without intervention, a CRAO will lead to blindness in the affected eye. Experimental studies have shown that after only 4 hours, an obstruction of the central retinal artery can result in massive irreversible cell death and retinal necrosis. Even with immediate treatment, the prognosis is poor, with only 21% to 35% of eyes retaining useful vision. Most of those who recover useful vision have a cilioretinal artery that preserves the central macula function.
With acute blockage of blood flow through the central retinal artery, profound vision loss ensues. A patient typically presents with sudden unilateral painless vision loss. There may be a history of amaurosis fugax in 10% of patients.
Embolism is the most common cause of CRAO, usually originating from the carotid arteries or the heart. Other causes include inflammation (including giant cell arteritis), vessel spasm, thrombosis, hypercoagulable state, hypertensive retinal necrosis, increased intraocular pressure, hemorrhage under an atherosclerotic plaque, and dissecting aneurysm within the central retinal artery.
Without intervention, a CRAO will lead to blindness in the affected eye. Experimental studies have shown that after only 4 hours, an obstruction of the central retinal artery can result in massive irreversible cell death and retinal necrosis. Even with immediate treatment, the prognosis is poor, with only 21% to 35% of eyes retaining useful vision. Most of those who recover useful vision have a cilioretinal artery that preserves the central macula function.
Codes
ICD10CM:
H34.10 – Central retinal artery occlusion, unspecified eye
SNOMEDCT:
38742007 – Central retinal artery occlusion
H34.10 – Central retinal artery occlusion, unspecified eye
SNOMEDCT:
38742007 – Central retinal artery occlusion
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Ophthalmic artery obstruction – no cherry-red spot
- Tay-Sachs disease – found in infants
- Arteritic anterior ischemic optic neuropathy
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Updated:04/07/2022