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Central Retinal Artery Occlusion Workup

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

Laboratory Studies

Laboratory studies are helpful in determining the etiology of central retinal artery occlusion (CRAO), as follows:

  • CBC count to evaluate anemia, polycythemia, and platelet disorders
  • Erythrocyte sedimentation rate (ESR) evaluation for giant cell arteritis
  • Fibrinogen, antiphospholipid antibodies, prothrombin time/activated partial thromboplastin time (PT/aPTT), and serum protein electrophoresis to evaluate for coagulopathies
  • Fasting blood sugar, cholesterol, triglycerides, and lipid panel to evaluate for atherosclerotic disease
  • Blood cultures to evaluate for bacterial endocarditis and septic emboli

Imaging Studies

Imaging studies are helpful in determining the etiology of CRAO.

Carotid ultrasound imaging to evaluate for atherosclerotic plaque. This appears to be more sensitive than carotid Doppler, which only determines the flow.

Magnetic resonance angiogram may be more accurate in detecting obstruction.

Fluorescein angiogram (see list below) is not mandatory as it doesn not influence therapy.

  • Delay in arteriovenous transit time (< 11 seconds is in the reference range)
  • Delay in retinal arterial filling
  • Normal choroidal filling (begins 1-2 seconds before retinal filling and completely filled within 5 seconds of dye appearance in healthy eyes). A delay of 5 seconds or greater is seen in 10% of patients. Consider ophthalmic artery occlusion or carotid artery obstruction if there is a significant delay in choroidal filling.
  • Arterial narrowing with normal fluorescein transit after recanalization

Other Tests

See the list below:

  • ECG to evaluate for possible atrial fibrillation (A 24-h Holter monitor may be necessary if arrhythmia is suspected but not detected on ECG testing.)
  • Electroretinogram shows a diminished b-wave corresponding to Muller and/or bipolar cell ischemia.
  • Echocardiogram (not necessarily an emergency department test)
    • To evaluate valvular disease, wall motion abnormalities, and mural thrombi
    • To evaluate vegetations that may cause septic emboli


The mainstay of therapy is procedure and pharmacologic therapy (see Medical Care and Medication).

Ocular massage

Apply direct pressure for 5-15 seconds, then release. Repeat several times.

A fundus contact lens or digital massage may be used.

Ocular massage can dislodge the embolus to a point further down the arterial circulation and improve retinal perfusion.

Anterior chamber paracentesis

Administer local anesthesia. Use a 30-gauge needle on a tuberculin syringe.

Enter the eye at the limbus with bevel up.

Ensure that the needle does not damage the lens.

Withdraw fluid until the anterior chamber shallows slightly (0.1-0.2 cc).

Administer a postprocedure topical antibiotic.

A decrease in intraocular pressure is believed to allow greater perfusion, pushing emboli further down the vascular tree.

Intra-arterial fibrinolysis

This procedure is controversial.[5]

Limited evidence of improved visual acuity with urokinase is available. A few cases of intra-arterial tissue plasminogen activator (tPA) administration have been observed to be successful.

Systemic complications include transient ischemic attack (TIA), stroke, and hematoma.

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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