Medication Summary

To prevent stroke, most patients with branch retinal artery occlusion (BRAO) are placed on some form of antiplatelet therapy, such as aspirin, clopidogrel (Plavix), dipyridamole (Aggrenox), and ticlopidine (Ticlid).

Warfarin (Coumadin) is a blood thinner that prevents the blood from clotting. This medication often is used in patients with atrial fibrillation to decrease their risk for stroke.

Chang M, Herbert WN. Retinal arteriolar occlusions following amniotic fluid embolism. Ophthalmology. 1984 Dec. 91(12):1634-7. [QxMD MEDLINE Link].
Chuang EL, Miller FS 3rd, Kalina RE. Retinal lesions following long bone fractures. Ophthalmology. 1985 Mar. 92(3):370-4. [QxMD MEDLINE Link].
Cohen SM, Davis JL, Gass DM. Branch retinal arterial occlusions in multifocal retinitis with optic nerve edema. Arch Ophthalmol. 1995 Oct. 113(10):1271-6. [QxMD MEDLINE Link].
Fineman MS, Savino PJ, Federman JL, Eagle RC Jr. Branch retinal artery occlusion as the initial sign of giant cell arteritis. Am J Ophthalmol. 1996 Sep. 122(3):428-30. [QxMD MEDLINE Link].
Friberg TR, Gragoudas ES, Regan CD. Talc emboli and macular ischemia in intravenous drug abuse. Arch Ophthalmol. 1979 Jun. 97(6):1089-91. [QxMD MEDLINE Link].
Gass JD, Tiedeman J, Thomas MA. Idiopathic recurrent branch retinal arterial occlusion. Ophthalmology. 1986 Sep. 93(9):1148-57. [QxMD MEDLINE Link].
Greven CM, Weaver RG, Owen J, Slusher MM. Protein S deficiency and bilateral branch retinal artery occlusion. Ophthalmology. 1991 Jan. 98(1):33-4. [QxMD MEDLINE Link].
Johnson MW, Thomley ML, Huang SS, Gass JD. Idiopathic recurrent branch retinal arterial occlusion. Natural history and laboratory evaluation. Ophthalmology. 1994 Mar. 101(3):480-9. [QxMD MEDLINE Link].
Nelson ME, Talbot JF, Preston FE. Recurrent multiple-branch retinal arteriolar occlusions in a patient with protein C deficiency. Graefes Arch Clin Exp Ophthalmol. 1989. 227(5):443-7. [QxMD MEDLINE Link].
Reichel E, Duker JS, Puliafito CA, Hedges TR 3rd, Caplan L. Branch retinal arterial occlusion caused by a preretinal arterial loop. Neurology. 1994 Jun. 44(6):1181-3. [QxMD MEDLINE Link].
Rush JA, Kearns TP, Danielson GK. Cloth-particle retinal emboli from artificial cardiac valves. Am J Ophthalmol. 1980 Jun. 89(6):845-50. [QxMD MEDLINE Link].
Williamson TH, Meyer PA. Branch retinal artery occlusion in toxoplasma retinochoroiditis. Br J Ophthalmol. 1991 Apr. 75(4):253. [QxMD MEDLINE Link].
Yasuma F, Tsuzuki M, Yasuma T. Retinal embolism from left atrial myxoma. Jpn Heart J. 1989 Jul. 30(4):527-32. [QxMD MEDLINE Link].
Zamora RL, Adelberg DA, Berger AS, Huettner P, Kaplan HJ. Branch retinal artery occlusion caused by a mitral valve papillary fibroelastoma. Am J Ophthalmol. 1995 Mar. 119(3):325-9. [QxMD MEDLINE Link].
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. 2015 Feb. 99 (2):227-31. [QxMD MEDLINE Link].
Bruno A, Jones WL, Austin JK, Carter S, Qualls C. Vascular outcome in men with asymptomatic retinal cholesterol emboli. A cohort study. Ann Intern Med. 1995 Feb 15. 122(4):249-53. [QxMD MEDLINE Link].
Chang YS, Jan RL, Weng SF, Wang JJ, Chio CC, Wei FT, et al. Retinal artery occlusion and the 3-year risk of stroke in Taiwan: a nationwide population-based study. Am J Ophthalmol. 2012 Oct. 154 (4):645-652.e1. [QxMD MEDLINE Link].
Mason JO 3rd, Patel SA, Feist RM, Albert MA Jr, Huisingh C, McGwin G Jr, et al. Ocular neovascularization in eyes with a central retinal artery occlusion or a branch retinal artery occlusion. Clin Ophthalmol. 2015. 9:995-1000. [QxMD MEDLINE Link].
Yamamoto K, Tsujikawa A, Hangai M, Fujihara M, Iwawaki T, Kurimoto Y. Neovascular glaucoma after branch retinal artery occlusion. Jpn J Ophthalmol. 2005 Sep-Oct. 49(5):388-90. [QxMD MEDLINE Link].
Ahuja RM, Chaturvedi S, Eliott D, Joshi N, Puklin JE, Abrams GW. Mechanisms of retinal arterial occlusive disease in African American and Caucasian patients. Stroke. 1999 Aug. 30(8):1506-9. [QxMD MEDLINE Link].
Hayreh SS, Zimmerman MB. Amaurosis fugax in ocular vascular occlusive disorders: prevalence and pathogeneses. Retina. 2014 Jan. 34(1):115-22. [QxMD MEDLINE Link].
Biousse V, Nahab F, Newman NJ. Management of Acute Retinal Ischemia: Follow the Guidelines!. Ophthalmology. 2018 Apr 30. [QxMD MEDLINE Link].
Sharma S, Pater JL, Lam M, Cruess AF. Can different types of retinal emboli be reliably differentiated from one another? An inter- and intraobserver agreement study. Can J Ophthalmol. 1998 Apr. 33(3):144-8. [QxMD MEDLINE Link].
Arruga J, Sanders MD. Ophthalmologic findings in 70 patients with evidence of retinal embolism. Ophthalmology. 1982 Dec. 89(12):1336-47. [QxMD MEDLINE Link].
Doubal FN, Hokke PE, Wardlaw JM. Retinal microvascular abnormalities and stroke: a systematic review. J Neurol Neurosurg Psychiatry. 2009 Feb. 80(2):158-65. [QxMD MEDLINE Link].
Aleman TS, Tapino PJ, Brucker AJ. Evidence of recurrent microvascular occlusions associated with acute branch retinal artery occlusion demonstrated with spectral-domain optical coherence tomography. Retina. 2012 Sep. 32(8):1687-8. [QxMD MEDLINE Link].
Ahmed HJ, Klefter ON, Willerslev A, Munch IC, Larsen M. Embolus characterization in branch retinal artery occlusion by optical coherence tomography. Acta Ophthalmol. 2014 Aug 13. [QxMD MEDLINE Link].
Bonini Filho MA, Adhi M, de Carlo TE, Ferrara D, Baumal CR, Witkin AJ, et al. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN RETINAL ARTERY OCCLUSION. Retina. 2015 Nov. 35 (11):2339-46. [QxMD MEDLINE Link].
Bonnin S, Krivosic V, Cognat E, Tadayoni R. Visibility of Blood Flow on Optical Coherence Tomography Angiography in a Case of Branch Retinal Artery Occlusion. J Ophthalmic Vis Res. 2018 Jan-Mar. 13 (1):75-77. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Man V, Hecht I, Talitman M, Hilely A, Midlij M, Burgansky-Eliash Z, et al. Treatment of retinal artery occlusion using transluminal Nd:YAG laser: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2017 Oct. 255 (10):1869-1877. [QxMD MEDLINE Link].
Brunner S, Binder S. Surgical embolus excision in retinal artery occlusion - two case reports. Acta Ophthalmol. 2013 Dec. 91(8):e652-3. [QxMD MEDLINE Link].
García-Arumí J, Martinez-Castillo V, Boixadera A, Fonollosa A, Corcostegui B. Surgical embolus removal in retinal artery occlusion. Br J Ophthalmol. 2006 Oct. 90(10):1252-5. [QxMD MEDLINE Link]. [Full Text].
Albert DM, Jakobiec FA. Principles and Practice of Ophthalmology. WB Saunders; 1994. Vol. 2: 727-35.
Blauth CI, Smith PL, Arnold JV, Jagoe JR, Wootton R, Taylor KM. Influence of oxygenator type on the prevalence and extent of microembolic retinal ischemia during cardiopulmonary bypass. Assessment by digital image analysis. J Thorac Cardiovasc Surg. 1990 Jan. 99(1):61-9. [QxMD MEDLINE Link].
Brown GC. Arterial obstruction disease and the eye. Int Ophthalmol Clin North Am. 1990. 3:373-92.
Brown GC, Magargal L, Augsburger JJ, Shields JA. Preretinal arterial loops and retinal arterial occlusion. Am J Ophthalmol. 1979 May. 87(5):646-51. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Brown GC, Magargal LE, Simeone FA, Goldberg RE, Federman JL, Benson WE. Arterial obstruction and ocular neovascularization. Ophthalmology. 1982 Feb. 89(2):139-46. [QxMD MEDLINE Link].
Brown GC, Reber R. An unusual presentation of branch retinal artery obstruction in association with ocular neovascularization. Can J Ophthalmol. 1986 Apr. 21(3):103-6. [QxMD MEDLINE Link].
Brown GC, Shields JA. Cilioretinal arteries and retinal arterial occlusion. Arch Ophthalmol. 1979 Jan. 97(1):84-92. [QxMD MEDLINE Link].
Dhar-Munshi S, Ayliffe WH, Jayne D. Branch retinal arteriolar occlusion associated with familial factor V Leiden polymorphism and positive rheumatoid factor. Arch Ophthalmol. 1999 Jul. 117(7):971-3. [QxMD MEDLINE Link].
Dori D, Beiran I, Gelfand Y, Lanir N, Scharf J, Miller B, et al. Multiple retinal arteriolar occlusions associated with coexisting primary antiphospholipid syndrome and factor V Leiden mutation. Am J Ophthalmol. 2000 Jan. 129(1):106-8. [QxMD MEDLINE Link].
Gass JD. Stereoscopic Atlas of Macular Diseases. 3rd ed. Mosby-Year Book; 1987. 340-60.
Gold D, Feiner L, Henkind P. Retinal arterial occlusive disease in systemic lupus erythematosus. Arch Ophthalmol. 1977 Sep. 95(9):1580-5. [QxMD MEDLINE Link].
Greven CM, Slusher MM, Weaver RG. Retinal arterial occlusions in young adults. Am J Ophthalmol. 1995 Dec. 120(6):776-83. [QxMD MEDLINE Link].
Guyer DR. Retina-Vitreous-Macula. WB Saunders; 1999. Vol. 1.: 271-85.
Hayreh SS, Kolder HE, Weingeist TA. Central retinal artery occlusion and retinal tolerance time. Ophthalmology. 1980 Jan. 87(1):75-8. [QxMD MEDLINE Link].
Hayreh SS, Podhajsky P. Ocular neovascularization with retinal vascular occlusion. II. Occurrence in central and branch retinal artery occlusion. Arch Ophthalmol. 1982 Oct. 100(10):1585-96. [QxMD MEDLINE Link].
Ho AM, Ling E. Systemic air embolism after lung trauma. Anesthesiology. 1999 Feb. 90(2):564-75. [QxMD MEDLINE Link].
Hollenhorst RW. Vascular status of patients who have cholesterol emboli in the retina. Am J Ophthalmol. 1966 May. 61(5 Pt 2):1159-65. [QxMD MEDLINE Link].
Howard RS, Russell RW. Prognosis of patients with retinal embolism. J Neurol Neurosurg Psychiatry. 1987 Sep. 50(9):1142-7. [QxMD MEDLINE Link].
Jacob HS, Goldstein IM, Shapiro I, Craddock PR, Hammerschmidt DE, Weissmann G. Sudden blindness in acute pancreatitis. Possible role of complement-induced retinal leukoembolization. Arch Intern Med. 1981 Jan. 141(1):134-6. [QxMD MEDLINE Link].
Karjalainen K. Occlusion of the central retinal artery and retinal branch arterioles. A clinical, tonographic and fluorescein angiographic study of 175 patients. Acta Ophthalmol Suppl. 1971. 109:1-95. [QxMD MEDLINE Link].
Klein R, Klein BE, Jensen SC, Moss SE, Meuer SM. Retinal emboli and stroke: the Beaver Dam Eye Study. Arch Ophthalmol. 1999 Aug. 117(8):1063-8. [QxMD MEDLINE Link].
Kollarits CR, Lubow M, Hissong SL. Retinal strokes. I. Incidence of carotid atheromata. JAMA. 1972 Dec 4. 222(10):1273-5. [QxMD MEDLINE Link].
Kraushar MF, Brown GC. Retinal neovascularization after branch retinal arterial obstruction. Am J Ophthalmol. 1987 Sep 15. 104(3):294-6. [QxMD MEDLINE Link].
Malinowski SM, Pesin SR. Visual field loss caused by retinal vascular occlusion after vitrectomy surgery. Am J Ophthalmol. 1997 May. 123(5):707-8. [QxMD MEDLINE Link].
Morgan CM, Schatz H, Vine AK, et al. Ocular complications associated with retrobulbar injections. Ophthalmology. 1988 May. 95(5):660-5. [QxMD MEDLINE Link].
Penner R, Font RL. Retinal embolism from calcified vegetations of aortic valve. Spontaneous complication of rheumatic heart disease. Arch Ophthalmol. 1969 Apr. 81(4):565-8. [QxMD MEDLINE Link].
Pfaffenbach DD, Hollenhorst RW. Morbidity and survivorship of patients with embolic cholesterol crystals in the ocular fundus. Am J Ophthalmol. 1973 Jan. 75(1):66-72. [QxMD MEDLINE Link].
Reese LT, Shafer D. Retinal embolization from endocarditis. Ann Ophthalmol. 1978 Dec;. 10(12):1655-7. [QxMD MEDLINE Link].
Ritter M, Sacu S, Deák GG, Kircher K, Sayegh RG, Pruente C, et al. In vivo identification of alteration of inner neurosensory layers in branch retinal artery occlusion. Br J Ophthalmol. 2012 Feb. 96(2):201-7. [QxMD MEDLINE Link]. [Full Text].
Ros MA, Magargal LE, Uram M. Branch retinal-artery obstruction: a review of 201 eyes. Ann Ophthalmol. 1989 Mar. 21(3):103-7. [QxMD MEDLINE Link].
Savino PJ, Glaser JS, Cassady J. Retinal stroke. Is the patient at risk?. Arch Ophthalmol. 1977 Jul. 95(7):1185-9. [QxMD MEDLINE Link].
Schatz H, Drake M. Self-injected retinal emboli. Ophthalmology. 1979 Mar. 86(3):468-83. [QxMD MEDLINE Link].
Shapiro I, Jacob HS. Leukoembolization in ocular vascular occlusion. Ann Ophthalmol. 1982 Jan. 14(1):60-2. [QxMD MEDLINE Link].
Sharma S, Sharma SM, Cruess AF, Brown GC. Transthoracic echocardiography in young patients with acute retinal arterial obstruction. RECO Study Group. Retinal Emboli of Cardiac Origin Group. Can J Ophthalmol. 1997 Feb. 32(1):38-41. [QxMD MEDLINE Link].
Soong HK, Newman SA, Kumar AA. Branch artery occlusion. An unusual complication of external carotid embolization. Arch Ophthalmol. 1982 Dec. 100(12):1909-11. [QxMD MEDLINE Link].
Spencer WH. Ophthalmic Pathology: An Atlas and Textbook. American Academy of Ophthalmology; 1985. Vol. 2.: 655-709.
Tayyanipour R, Pulido JS, Postel EA, Lipkowitz JL, Pisciotta A, Braza E. Arterial vascular occlusion associated with factor V Leiden gene mutation. Retina. 1998. 18(4):376-7. [QxMD MEDLINE Link].
Vine AK, Samama MM. The role of abnormalities in the anticoagulant and fibrinolytic systems in retinal vascular occlusions. Surv Ophthalmol. 1993 Jan-Feb. 37(4):283-92. [QxMD MEDLINE Link].
Wang MY, Arnold AC, Vinters HV, Glasgow BJ. Bilateral blindness and lumbosacral myelopathy associated with high-dose carmustine and cisplatin therapy. Am J Ophthalmol. 2000 Sep. 130(3):367-8. [QxMD MEDLINE Link].
Whiteman DW, Rosen DA, Pinkerton RM. Retinal and choroidal microvascular embolism after intranasal corticosteroid injection. Am J Ophthalmol. Jun 1980. 89(6):851-3. [QxMD MEDLINE Link].
Wilkinson WS, Morgan CM, Baruh E, Gitter KA. Retinal and choroidal vascular occlusion secondary to corticosteroid embolisation. Br J Ophthalmol. 1989 Jan. 73(1):32-4. [QxMD MEDLINE Link].
Younge BR. The significance of retinal emboli. J Clin Neuroophthalmol. 1989 Sep. 9(3):190-4. [QxMD MEDLINE Link].

Media Gallery

Fluorescein angiogram of right eye with inferior branch retinal artery occlusion. Delayed filling of the artery (arrow heads) by the fluorescein is noted.
Red-free photograph (before injection of fluorescein) of right eye with inferior branch retinal artery occlusion. The red-free photograph greatly accentuates the retinal whitening surrounding the occluded artery.
Color fundus photo of right eye with inferior branch retinal artery occlusion from a platelet-fibrin embolus. Retinal whitening surrounding the occluded artery is noted.
Optical coherence tomography (OCT) of right eye with inferior branch retinal artery occlusion. Cross-section goes through inferior retina to superior retina, capturing the abnormally thickened retina associated with intracellular edema.
Optical coherence tomography (OCT) over time of a branch retinal artery occlusion. Taken 24 hours after symptom onset, A shows an unaffected portion of the macula, while B shows swelling of the inner retina in the area affected by the branch retinal artery occlusion (BRAO). Two weeks later, this swelling/increased thickness is beginning to resolve (C). Two months later, the inner retina has thinned notably, and the inner plexiform layer, inner nuclear layer, and outer plexiform layer are difficult to distinguish from one another. Courtesy of British Journal of Ophthalmology.
Color fundus photo of left eye with branch retinal artery occlusion caused by embolization of ethylene vinyl alcohol copolymer (Onyx), a liquid embolic agent used in the treatment of saccular aneurysms, into the retinal circulation. Courtesy of Vanderbilt Eye Institute.
Color fundus photo of right eye with inferior branch retinal artery occlusion. Courtesy of Vanderbilt Eye Institute.
Color fundus photo of right eye with superior branch retinal artery occlusion. Courtesy of Vanderbilt Eye Institute.

of 8

Author

Rishabh C Date, MD Retina Specialist and Vitreoretinal Surgeon, NJ Retina

Rishabh C Date, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Janice C Law, MD Assistant Professor, Associate Program Director, Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute

Janice C Law, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, Phi Beta Kappa, Michigan Society of Eye Physicians & Surgeons

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 Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

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.

Enrique Garcia-Valenzuela, MD, PhD Clinical Assistant Professor, Department of Ophthalmology, University of Illinois Eye and Ear Infirmary; Consulting Staff, Vitreo-Retinal Surgery, Midwest Retina Consultants, SC, Parkside Center

Enrique Garcia-Valenzuela, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Retina Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Dean Eliott, MD Associate Director, Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School

Dean Eliott, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association

Disclosure: Nothing to disclose.

Gary W Abrams, MD Professor and Chairman, Department of Ophthalmology, Wayne State University School of Medicine; Director, Kresge Eye Institute

Gary W Abrams, 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, Macula Society, Retina Society, Pan-American Association of Ophthalmology, Societas Internationalis Pro Diagnostica Ultrasonica in Ophthalmologia, Club Jules Gonin

Disclosure: Nothing to disclose.

Niraj R Nathan, MD Glaucoma Fellow, Department of Ophthalmology, Baylor College of Medicine

Niraj R Nathan, MD is a member of the following medical societies: Tennessee Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Rubin W Kim, MD Staff Physician, Department of Ophthalmology, Kresge Eye Institute

Rubin W Kim, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.