Central Retinal Artery Occlusion

Question 1

Causes of CRAO

Answer 1

atherosclerosis (most common)

giant cell arteritis

Question 2

Risk factors for CRAO

Answer 2

In context of atherosclerosis - smoking, diabetes, hypertension, hypercholesterolaemia

In context of giant cell arteritis - white ethnicity, female, older age, polymyalgia rheumatics

Question 3

Signs and symptoms of CRAO

Answer 3

Symptoms:

Sudden onset painless vision loss - ‘curtain coming down over vision’

Signs:

RAPD

Question 4

Key differentials for sudden onset, painless loss of vision?

Answer 4

CRAO
CRVO
Retinal detachment
Vitreous haemorrhage

Question 5

Acute management of CRAO

Answer 5

Medical emergency
Reverse giant cell arteritis - do ESR, temporal artery biopsy, give steroids
Occular massage
Anterior chamber paracentesis
Inhaled carbogen
IV acetazolamide, IV mannitol
Sublingual isosorbide dinitrate
Oral pentoxifyline
Topical timolol

Question 6

Investigations for CRAO

Answer 6

Fundoscopy - pale retina with cherry red spot