Retinal artery occlusion

Retina

The retina is the internal layer of the eye that receives and transmits focused images. The retina is normally red due to its rich blood supply.

Also known as: Central retinal artery occlusion, Branch retinal artery occlusion, CRAO or BRAO

Definition

Retinal artery occlusion is a blockage in one of the small arteries that carry blood to the retina. The retina is a layer of tissue in the back of the eye that is able to sense light.

Causes, incidence, and risk factors

Retinal arteries may become blocked by a blood clot or fat deposits that get stuck in the arteries. These blockages are more likely if there is hardening of the arteries (atherosclerosis) in the eye.

Clots may travel from other parts of the body and block an artery in the retina. The most common sources of clots are the carotid artery in the neck and the heart.

Most clots occur in people with conditions such as:

If a branch of the retinal artery is blocked, part of the retina will not receive enough blood and oxygen. If this happens, you may lose part of your vision.

Symptoms

Sudden blurring or loss of vision may occur in:

  • All of one eye (central retinal artery occlusion or CRAO)
  • Part of one eye (branch retinal artery occlusion or BRAO)

The retinal artery occlusion may last for only a few seconds or minutes, or it may be permanent.

If the blood clot moves to another part of the brain, symptoms of a stroke may develop.

Signs and tests

Tests to evaluate the retina may include:

General tests should include:

Tests to identify the source of a clot from another part of the body:

Treatment

There is no proven treatment for vision loss that involves the whole eye, unless it is caused by another illness that can be treated.

Several treatments may be tried. These treatments must be given within 2 - 4 hours after symptoms begin to be helpful. However, the benefit of these treatments has never been proven, and they are rarely used.

  • Breathing in (inhaling) a carbon dioxide-oxygen mixture. This treatment causes the arteries of the retina to widen (dilate).
  • Massage of the eye
  • The clot-busting drug, tissue plasminogen activator (tPA)

The health care provider should look for the cause of the blockage. Blockages may be signs of a life-threatening medical problem.

Expectations (prognosis)

People with blockages of the retinal artery may not get their vision back.

Complications

  • Glaucoma (CRAO only)
  • Partial or complete loss of vision in the affected eye
  • Stroke (due to the same factors that contribute to retinal artery occlusion, not due to the occlusion itself)

Calling your health care provider

Call your health care provider if you have sudden blurring or vision loss.

Prevention

Measures used to prevent other blood vessel (vascular) diseases, such as coronary artery disease, may decrease the risk of retinal artery occlusion. These include:

  • Eating a low-fat diet
  • Exercising
  • Stopping smoking
  • Losing weight if you are overweight

Sometimes blood thinners may be used to prevent the artery from becoming blocked again. Aspirin or other anti-clotting drugs are used if the problem is in the carotid arteries. Warfarin or other more potent blood thinners are used if the problem is in the heart.

References

Duker JS. Retinal arterial occlusion. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. Maryland Heights, Mo: Mosby Elsevier;2008:chap 6.16.

Fay A. Diseases of the visual system. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 449.

Pokhrel PK, Loftus SA. Occular emergencies. Am Fam Physician. 2007;76:829-836.

Vortmann M, Schneider JI. Acute monocular visual loss. Emerg Med Clin North Am. 2008;26:73-96.

See also:

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    Carotid stenosis, X-ray of the left artery

    Atherosclerosis is a condition in which fatty material collects along the walls of arteries. This fatty material thickens, hardens (forms calcium deposits), and may eventually block the arteries. Atherosclerosis is a type of arteriosclerosis. The two terms are often used to mean the same thing.

  • Special Topic

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    Blood clots

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    Hypertension

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Review date:
April 15, 2010
Reviewed by:
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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