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Central Retinal Artery Occlusion Treatment & Management

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

Medical Care

Immediate lowering of intraocular pressure includes acetazolamide 500 mg IV or 500 mg PO once.

Topical medications are used to lower intraocular pressure.

Further treatments are as follows:

  • Some physicians recommend carbogen therapy (5% CO2, 95% O2): CO2 dilates retinal arterioles, and O2 increases oxygen delivery to ischemic tissues. Perform for 10 minutes every 2 hours for 48 hours. There is no Level 1 scientific evidence that is effective however.
  • Hyperbaric oxygen therapy (HBOT) may be beneficial if begun within 2-12 hours of symptom onset. Institute treatment with other interventions first, as transport to a chamber may usurp precious time. There is no Level 1 evidence that the improvement noted after hyperbaric oxygen therapy is sustainable however.
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Surgical Care

Ahn et al report that intra-arterial thrombolysis in CRAO does not significantly alter visual acuity compared with standard medical care of intraocular pressure lowering agents and ocular massage.[6]

In a retrospective analysis, paracentesis of the anterior chamber to lower the intraocular pressure acutely has shown no added benefit in final visual acuity.[7]

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Consultations

Hyperbaric medicine

Early treatment (< 2 h from onset of symptoms) with HBOT may be associated with increased visual recovery, but HBOT can be considered if the duration of visual loss is less than 12 hours.

Inhalation of 100% oxygen at 2 atmospheric absolute provides an arterial pO2 of 1000-1200 mm Hg, resulting in a 3-fold increase in oxygen diffusion distance through ischemic retinal tissues. Some studies show a 40% improvement of 2 or more levels of visual acuity.

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Contributor Information and Disclosures
Author

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.

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, 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.

Acknowledgements

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.

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