Medical Care

Considering the increased rate of mortality, patients with branch retinal artery occlusion (BRAO) should receive a full medical workup with special attention to the cerebrovascular and cardiovascular system. Depending on the findings, carotid endarterectomy or anticoagulation may be indicated. Laboratory workup for coagulopathies should be performed if no embolic source is found.

Surgical Care

Surgical embolus excision has been described in a few case reports, with the authors reporting good visual outcome and safety.^{[32, 33]}Given the natural history of frequent spontaneous visual improvement and generally good visual outcome in untreated BRAO, further investigation with a randomized controlled trial likely is needed to validate surgical embolus excision as a treatment option in BRAO.

Consultations

Refer to an internist for complete systemic workup.

Prevention

Controlling blood pressure, cholesterol, and diabetes can greatly reduce the risk for atherosclerotic disease.

Smoking cessation can lower the risk for stroke.

Long-Term Monitoring

Patients initially should be evaluated every 3-6 months to monitor progression.

Ocular neovascularization after BRAO is rare. If neovascularization occurs, panretinal photocoagulation should be performed.

Medication

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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.