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

Central retinal artery occlusion - External and Internal Eye

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Contributors: Rachel Ellis MD, Andrew Goodfriend MD, Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD, Lauren Patty Daskivich MD, MSHS
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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. 

Codes

ICD10CM:
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

Best Tests

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Management Pearls

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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: 01/28/2013
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Emergency: requires immediate attention
Central retinal artery occlusion - External and Internal Eye
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Central retinal artery occlusion : Cherry red spot, Developed rapidly , Narrowed retinal vessels, Unilateral
Clinical image of Central retinal artery occlusion
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