Central retinal artery occlusion

Question 1

What is central retinal artery occlusion?

Answer 1

The sudden blockage of the central retinal artery, obstructing blood flow to the eye

Question 2

What are the causes of central retinal artery occlusion?

Answer 2

Most commonly caused by an embolism, but can be caused by arteritis

Question 3

Where does the central retinal artery supply?

Answer 3

It supplies blood to the optic nerve, and the inner two thirds of the retina

Question 4

What are the risk factors for central retinal artery occlusion?

Answer 4

Cardiovascular disease
Diabetes
Hypertension
Older age
Female
Polymyalgia rheumatica
Carotid artery stenosis

Question 5

What is the presentation of central retinal artery occlusion?

Answer 5

Sudden painless loss of vision
Reduced visual acuity
Afferent pupillary defect
Pale retina
Cherry red spot on fundoscopy

Question 6

What investigations may be useful alongside a clinical diagnosis of central retinal artery occlusion?

Answer 6

ESR/CRP - investigate for underlying temporal arteritis
Vasculitis screening
Coagulation screen
HbA1c/lipid profile

Question 7

What is the initial management of central retinal artery occlusion?

Answer 7

Reperfusion therapy
- Pentoxifylline or hyperbaric oxygen
Reduction in intraocular pressure
- Acetazolomide or mannitol
IV steroids
Thrombolytic therapy

Question 8

What is the long term management of central retinal artery occlusion?

Answer 8

Reduction in cardiovascular risk
DVLA notification if there is complete loss of vision in one eye