eMedicine Specialties > Ophthalmology > Retina

Central Retinal Artery Occlusion: Follow-up

Author: Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Coauthor(s): Shehab A Ebrahim, MD, Assistant Professor, Department of Ophthalmology, Tulane University; Vitreoretinal Surgeon, The Retina Institute, LLC
Contributor Information and Disclosures

Updated: Feb 12, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is indicated only if comorbid disease is present.

Further Outpatient Care

  • A follow-up ophthalmic examination should be performed 1-4 weeks after the event to check for neovascularization of the disc or iris.
    • Neovascularization of the iris occurs in 20% of patients at an average of 4-5 weeks after the event. The range is 1-15 weeks. Panretinal photocoagulation is effective in causing regression of iris neovascularization in 65% of patients.
    • Neovascularization of the disc occurs in 2-3% of patients. Panretinal photocoagulation is effective for optic disc neovascularization.
  • A complete systemic workup should be performed by a primary care provider.
  • If hyperbaric oxygen therapy (HBOT) is to be used, several treatments may be necessary.

Inpatient & Outpatient Medications

  • In/out patient medications are indicated only if comorbid disease is present.

Transfer

  • Transfer to a hyperbaric facility is necessary if HBOT is to be administered.

Deterrence/Prevention

  • Patients should control their blood pressure, lower their cholesterol, avoid intravenous drugs, and take their medication.

Complications

  • Further emboli to the brain resulting in a cerebrovascular accident
  • Further emboli to the same or contralateral eye, resulting in further visual loss
  • Progression of temporal arteritis, resulting in loss of vision to the contralateral eye

Prognosis

  • Most patients continue to experience severe vision loss in the counting fingers to hand motion range.
  • As many as 10% of patients retain central vision because of the presence of a cilioretinal artery. In this case, visual acuity improves to 20/50 or better in 80% of cases over a 2-week period.
  • The presence of a retinal embolus is associated with a 56% mortality rate over 9 years compared to 27% in patients without arterial emboli.
  • Life expectancy of patients with central retinal artery occlusion (CRAO) is 5.5 years compared to 15.4 years for an age-matched population without CRAO.

Patient Education

  • Patients must understand that the prognosis for visual recovery is poor and that the visual changes are usually a result of a systemic process that needs treatment.

Miscellaneous

Medicolegal Pitfalls

  • Failure to perform a workup of the systemic cause of CRAO, leading to a progression of disease or recurrence of symptoms
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthors, Enoch Huang, MD, MPH, and DooHo Brian Kim, BA, to the development and writing of this article.



More on Central Retinal Artery Occlusion

Overview: Central Retinal Artery Occlusion
Differential Diagnoses & Workup: Central Retinal Artery Occlusion
Treatment & Medication: Central Retinal Artery Occlusion
Follow-up: Central Retinal Artery Occlusion
References
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Further Reading

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Keywords

central retinal artery occlusion, central retina artery occlusion, CRAO, ophthalmic artery occlusion, central retinal artery, retinal artery occlusion, RAO, branch retinal artery occlusion, BRAO, embolism of the retinal artery, retinal artery emboli, ocular stroke, retina, visual loss, vision loss, loss of vision, blindness

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Contributor Information and Disclosures

Author

Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Arizona Ophthalmological Society
Disclosure: WebMD/eMedicine Salary Employment

Coauthor(s)

Shehab A Ebrahim, MD, Assistant Professor, Department of Ophthalmology, Tulane University; Vitreoretinal Surgeon, The Retina Institute, LLC
Shehab A Ebrahim, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Retina Specialists, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

V Al Pakalnis, MD, PhD, Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center
V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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