Central retinal artery occlusion: an eye stroke
- Emergency
Sudden painless visual loss with a pale retina and a cherry-red spot is an eye stroke: emergency stroke pathway, and over 50, exclude giant cell arteritis.
See it in 3D: Central retinal artery · Ophthalmic artery · Retina · Macula
What it is
Central retinal artery occlusion blocks the blood supply of the inner retina, usually with an embolus from the carotid artery or the heart. The retina tolerates ischaemia for only a few hours. It is now managed as an acute ischaemic stroke: the same risk factors, the same urgent workup and a high risk of brain stroke in the following weeks. A small share of cases are caused by giant cell arteritis.
How to recognise it
- Sudden, painless, profound loss of vision in one eye.
- Relative afferent pupillary defect.
- Pale, swollen retina with a cherry-red spot at the fovea; sometimes a visible embolus.
- Central vision spared if a cilioretinal artery supplies the macula.
- Over 50 with headache, jaw claudication or scalp tenderness: giant cell arteritis.
What to do at once
- Record the exact time of onset or the last time vision was normal.
- Measure acuity, check for an afferent pupillary defect and look at the fundus.
- Send to the emergency department of a stroke centre without delay, as for a brain stroke.
- Order ESR, CRP and a blood count in patients over 50, and start corticosteroids if arteritis is suspected.
- Arrange brain imaging (MRI with diffusion if available), vessel imaging of the neck and head, ECG and rhythm monitoring.
Mistakes that cost sight
- MRI often shows silent brain infarcts at the same time, which is why the workup is that of a stroke.
- Ocular massage, anterior chamber paracentesis and pressure-lowering drops have not been shown to help.
- Intravenous thrombolysis within the first hours is considered in some stroke centres, but the evidence is still limited.
- New vessels on the iris can appear in the following weeks and cause neovascular glaucoma.
Next step / Initial management
- Emergency stroke pathway within hours of onset: neurology or stroke team and ophthalmology.
- Workup: brain imaging, carotid imaging, ECG and rhythm monitoring, echocardiography, glucose, lipids, blood count; ESR and CRP over 50; thrombophilia tests in young patients.
- Secondary prevention as for stroke: antiplatelet therapy, statin, blood pressure and glucose control, carotid surgery for significant stenosis, anticoagulation for atrial fibrillation.
- Ophthalmology follow-up in the following weeks to detect iris or angle new vessels and treat them with laser.
Test yourself
Think of the answer, then tap the question to see it.
Why is central retinal artery occlusion managed as a stroke?
It shares the causes and risk factors of ischaemic stroke, often comes with silent brain infarcts, and carries a high early risk of brain stroke.
What explains the cherry-red spot?
The ischaemic inner retina turns pale and opaque, while the thin fovea lets the normal choroidal circulation show through.
Which tests are added in a patient over 50 with CRAO?
ESR and CRP (with a blood count) to look for giant cell arteritis.
Elsewhere in DurgiPedia
Connections
See it in 3D4
The structures of Durgical's 3D anatomy where it is found.
In Pharmacology1
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Central Retinal Artery Occlusion (StatPearls Publishing (NCBI Bookshelf), 2024); Hyperbaric Treatment of Central Retinal Artery Occlusion (StatPearls Publishing (NCBI Bookshelf), 2026); Giant Cell Arteritis (Temporal Arteritis) (StatPearls Publishing (NCBI Bookshelf), 2024).
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Representative model, for educational purposes only.