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Central Retinal Artery Occlusion Follow-up

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Aug 12, 2015

Further Outpatient Care

See the list below:

  • 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. Intravitreal injection of an anti-VEGF agent is first-line therapy for iris, trabecular meshwork, or 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, although this treatment is unproven.

Further Inpatient Care

Inpatient care is indicated only if comorbid disease is present.


Inpatient & Outpatient Medications

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



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



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



See the list below:

  • 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


Most patients continue to experience severe vision loss in the counting fingers to hand motion range.[8]

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.

Contributor Information and Disclosures

Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, Arizona Ophthalmological Society, American Medical Association

Disclosure: Partner received salary from Medscape/WebMD for employment.


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, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

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, South Carolina Medical Association

Disclosure: Nothing to disclose.


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

  1. Hayreh SS, Kolder HE, Weingeist TA. Central retinal artery occlusion and retinal tolerance time. Ophthalmology. 1980 Jan. 87(1):75-8. [Medline].

  2. Chang YS, Chu CC, Weng SF, Chang C, Wang JJ, Jan RL. The risk of acute coronary syndrome after retinal artery occlusion: a population-based cohort study. Br J Ophthalmol. 2014 Aug 21. [Medline].

  3. Chen Y, Wang W, Li J, Yu Y, Li L, Lu N. Fundus artery occlusion caused by cosmetic facial injections. Chin Med J (Engl). 2014. 127(8):1434-7. [Medline].

  4. Carle MV, Roe R, Novack R, Boyer DS. Cosmetic facial fillers and severe vision loss. JAMA Ophthalmol. 2014 May. 132(5):637-9. [Medline].

  5. Schumacher M, Schmidt D, Jurklies B, Gall C, Wanke I, Schmoor C, et al. Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial. Ophthalmology. 2010 Jul. 117(7):1367-75.e1. [Medline].

  6. Ahn SJ, Kim JM, Hong JH, Woo SJ, Ahn J, Park KH, et al. Efficacy and safety of intra-arterial thrombolysis in central retinal artery occlusion. Invest Ophthalmol Vis Sci. 2013 Nov 21. 54(12):7746-55. [Medline].

  7. Fieß A, Cal Ö, Kehrein S, Halstenberg S, Frisch I, Steinhorst UH. Anterior chamber paracentesis after central retinal artery occlusion: a tenable therapy?. BMC Ophthalmol. 2014 Mar 10. 14:28. [Medline]. [Full Text].

  8. Rudkin AK, Lee AW, Aldrich E, Miller NR, Chen CS. Clinical characteristics and outcome of current standard management of central retinal artery occlusion. Clin Experiment Ophthalmol. 2010 Jul. 38(5):496-501. [Medline].

  9. Aldrich EM, Lee AW, Chen CS, et al. Local intraarterial fibrinolysis administered in aliquots for the treatment of central retinal artery occlusion: the Johns Hopkins Hospital experience. Stroke. 2008 Jun. 39(6):1746-50. [Medline].

  10. Atebara NH, Brown GC, Cater J. Efficacy of anterior chamber paracentesis and Carbogen in treating acute nonarteritic central retinal artery occlusion. Ophthalmology. 1995 Dec. 102(12):2029-34; discussion 2034-5. [Medline].

  11. Augsburger JJ, Magargal LE. Visual prognosis following treatment of acute central retinal artery obstruction. Br J Ophthalmol. 1980 Dec. 64(12):913-7. [Medline].

  12. Beiran I, Reissman P, Scharf J, Nahum Z, Miller B. Hyperbaric oxygenation combined with nifedipine treatment for recent-onset retinal artery occlusion. Eur J Ophthalmol. 1993 Apr-Jun. 3(2):89-94. [Medline].

  13. Biousse V, Calvetti O, Bruce BB, Newman NJ. Thrombolysis for central retinal artery occlusion. J Neuroophthalmol. 2007 Sep. 27(3):215-30. [Medline].

  14. Brown G. Retinal arterial occlusive disease. Guyer DR, ed. Retina-Vitreous-Macula. WB Saunders; 1999. Vol. 1: 271-85.

  15. Brown GC. Retinal artery obstructive disease. Ryan SJ, ed. Retina. Mosby-Year Book; 1994. Vol 2: 1361-77.

  16. Brown GC, Magargal LE, Shields JA, Goldberg RE, Walsh PN. Retinal arterial obstruction in children and young adults. Ophthalmology. 1981 Jan. 88(1):18-25. [Medline].

  17. Carrero JL, Sanjurjo FJ. Bilateral cilioretinal artery occlusion in antiphospholipid syndrome. Retina. 2006 Jan. 26(1):104-6. [Medline].

  18. Chen CS, Lee AW. Management of acute central retinal artery occlusion. Nat Clin Pract Neurol. 2008 Jul. 4(7):376-83. [Medline].

  19. Feist RM, Emond TL. Translumenal Nd:YAG laser embolysis for central retinal artery occlusion. Retina. 2005 Sep. 25(6):797-9. [Medline].

  20. Ffytche TJ, Bulpitt CJ, Kohner EM, Archer D, Dollery CT. Effect of changes in intraocular pressure on the retinal microcirculation. Br J Ophthalmol. 1974 May. 58(5):514-22. [Medline].

  21. Hattenbach LO, Kuhli-Hattenbach C, Scharrer I, Baatz H. Intravenous thrombolysis with low-dose recombinant tissue plasminogen activator in central retinal artery occlusion. Am J Ophthalmol. 2008 Nov. 146(5):700-6. [Medline].

  22. Hayreh SS. Prevalent misconceptions about acute retinal vascular occlusive disorders. Prog Retin Eye Res. 2005 Jul. 24(4):493-519. [Medline].

  23. Hayreh SS, Zimmerman MB. Central retinal artery occlusion: visual outcome. Am J Ophthalmol. 2005 Sep. 140(3):376-91. [Medline].

  24. Hayreh SS, Zimmerman MB. Fundus changes in central retinal artery occlusion. Retina. 2007 Mar. 27(3):276-89. [Medline].

  25. Hertzog LM, Meyer GW, Carson S. Central retinal artery occlusion treated with hyperbaric oxygen. Journal of Hyperbaric Medicine. 1992. 7:33-42.

  26. Knoop K, Trott A. Ophthalmologic procedures in the emergency department--Part I: Immediate sight-saving procedures. Acad Emerg Med. 1994 Jul-Aug. 1(4):408-12. [Medline].

  27. Lacy C, Armstrong LL, Ingram N. Drug Information Handbook. 4th ed. Cleveland: Lexi-Comp, Inc; 1996.

  28. Magargal LE, Goldberg RE. Anterior chamber paracentesis in the management of acute nonarteritic central retinal artery occlusion. Surg Forum. 1977. 28:518-21. [Medline].

  29. Mangat HS. Retinal artery occlusion. Surv Ophthalmol. 1995 Sep-Oct. 40(2):145-56. [Medline].

  30. Miyake Y, Horiguchi M, Matsuura M. Hyperbaric oxygen therapy in 72 eyes with retinal arterial occlusion. 9th International Symposium on Underwater and Hyperbaric Physiology. Underwater and Hyperbaric Medical Society; 1987. 949-53.

  31. Noble J, Weizblit N, Baerlocher MO, Eng KT. Intra-arterial thrombolysis for central retinal artery occlusion: a systematic review. Br J Ophthalmol. 2008 May. 92(5):588-93. [Medline].

  32. Ozdemir H, Karacorlu S, Karacorlu M. Optical coherence tomography findings in central retinal artery occlusion. Retina. 2006 Jan. 26(1):110-2. [Medline].

  33. Rhee DJ, Pyfer M. Central retinal artery occlusion. Wills Eye Manual: Office & Emergency Room Diagnosis & Treatment of Eye Disease. Lippincott Williams & Wilkins; 2000. 331-5.

  34. Schmidt D, Schumacher M, Wakhloo AK. Microcatheter urokinase infusion in central retinal artery occlusion. Am J Ophthalmol. 1992 Apr 15. 113(4):429-34. [Medline].

  35. Scott I, Flynn H, Rosa R. Other retinal vascular disease. Atlas of Ophthalmology. New York: Springer-Verlag; 2000. 297.

  36. Shinoda K, Yamada K, Matsumoto CS, Kimoto K, Nakatsuka K. Changes in retinal thickness are correlated with alterations of electroretinogram in eyes with central retinal artery occlusion. Graefes Arch Clin Exp Ophthalmol. 2008 Jul. 246(7):949-54. [Medline].

  37. Weber J, Remonda L, Mattle HP, et al. Selective intra-arterial fibrinolysis of acute central retinal artery occlusion. Stroke. 1998 Oct. 29(10):2076-9. [Medline].

  38. Wolintz RJ. Carotid endarterectomy for ophthalmic manifestations: is it ever indicated?. J Neuroophthalmol. 2005 Dec. 25(4):299-302. [Medline].

  39. Wray SH. The management of acute visual failure. J Neurol Neurosurg Psychiatry. 1993 Mar. 56(3):234-40. [Medline].

  40. Yanoff M, Fine B. Ocular Pathology: A Color Atlas. Lippincott-Raven; 1988. 133-5.

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