Central Retinal Artery Occlusion Medication

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 16, 2012
 

Medication Summary

Medical therapy is directed toward lowering IOP, increasing retinal perfusion, and increasing oxygen delivery to hypoxic tissues. The first goal is accomplished by using the same drugs as those used in glaucoma. Retinal perfusion may be increased by vasodilatory drugs, increasing arterial pCO2, or by giving peripheral thrombolytics to remove the offending embolus. Some also advocate aspirin use in the acute phase. Oxygen delivery is improved by breathing higher concentrations of oxygen or with hyperbaric oxygen.

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Carbonic anhydrase inhibitors

Class Summary

Carbonic anhydrase is an enzyme found in many tissues of the body, including the eye. The reversible reaction it catalyzes involves the hydration of carbon dioxide and the dehydration of carbonic acid.

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Acetazolamide (Diamox)

 

Reduces rate of aqueous humor formation by inhibiting enzyme carbonic anhydrase, which results in decreased IOP. Used most frequently as single diuretic agent in acute management of CRAO. Other diuretics may be added if sufficient decrease in IOP is not attained.

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Dorzolamide (Trusopt)

 

Used concomitantly with other topical ophthalmic drug products to lower IOP. If more than one ophthalmic drug is being used, administer the drugs at least 10 min apart. Reversibly inhibits carbonic anhydrase, reducing hydrogen ion secretion at renal tubule and increases renal excretion of sodium, potassium bicarbonate, and water to decrease production of aqueous humor.

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Hyperosmotic diuretics

Class Summary

Lower IOP by creating an osmotic gradient between the ocular fluids and plasma (not for long-term use).

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Mannitol (Osmitrol)

 

Reduces elevated IOP when the pressure cannot be lowered by other means. Initially assess for adequate renal function in adults by administering a test dose of 200 mg/kg, given IV over 3-5 min. It should produce a urine flow of at least 30-50 mL/h of urine over 2-3 h. In children, assess for adequate renal function by administering a test dose of 200 mg/kg, given IV over 3-5 min. It should produce a urine flow of at least 1 mL/h over 1-3 h.

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Glycerin

 

Used in glaucoma to interrupt acute attacks. Oral osmotic agent for reducing IOP. Able to increase tonicity of blood until finally metabolized and eliminated by the kidneys. Maximum reduction of IOP usually occurs 1 h after glycerin administration. Effect usually lasts approximately 5 h.

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Sympathomimetics

Class Summary

Lower IOP mainly by increasing outflow and reducing the production of aqueous humor. The combination of a miotic and a sympathomimetic has additive effects in lowering IOP. Each may be added in rotation after a 5-minute interval, until target IOP is reached.

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Apraclonidine (Iopidine)

 

Reduces elevated, as well as normal, IOP whether or not accompanied by glaucoma. Apraclonidine is a relatively selective alpha-adrenergic agonist that does not have significant local anesthetic activity. Has minimal cardiovascular effects.

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Dipivefrin (AKPro, Propine)

 

Converted to epinephrine in eye by enzymatic hydrolysis. Appears to act by decreasing aqueous production and enhancing outflow facility. Has same therapeutic effect as epinephrine with fewer local and systemic side effects. May be used as an initial therapy or as an adjunct with other antiglaucoma agents for the control of IOP.

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Beta-adrenergic blocking agents

Class Summary

Lower IOP by decreasing the rate of aqueous humor production and possibly outflow. They may be more effective than either pilocarpine or epinephrine alone and have the advantage of not affecting pupil size or accommodation.

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Timolol ophthalmic (Timoptic)

 

May reduce elevated and normal IOP, with or without glaucoma by reducing the production of aqueous humor or by outflow.

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Corticosteroids

Class Summary

Used in arterial occlusion only when temporal arteritis (GCA) is the suspected or confirmed etiology.

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Prednisone (Deltasone, Orasone, Meticorten)

 

Useful in the treatment of inflammatory and allergic reactions. May decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear lymphocyte activity.

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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.

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

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 Other; Topcon Medical Lasers Consulting fee Consulting

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.

Additional Contributors

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.

References

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

  2. 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. Jul 2010;117(7):1367-75.e1. [Medline].

  3. 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. Jul 2010;38(5):496-501. [Medline].

  4. 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. Jun 2008;39(6):1746-50. [Medline].

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

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

  7. 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. Apr-Jun 1993;3(2):89-94. [Medline].

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

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

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

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

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

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

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

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

  16. 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. Nov 2008;146(5):700-6. [Medline].

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  31. 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. Jul 2008;246(7):949-54. [Medline].

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

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

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

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

 
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