Central Retinal Artery Occlusion with Sudden Vision Loss—“Ay, Ay, My Eye!”

Sudden monocular blindness with or without macular sparing is a central retinal artery occlusion until proven otherwise. It has some characteristic findings that appear on funduscopic exam that can be pathognomonic for the diagnosis. An afferent pupillary defect is often seen indicating a decrease in light perception in the affected eye. The workup for a patient with CRAO includes evaluation for sources of emboli, inflammatory markers, and possibly testing for a hypercoagulable state. Success of treatment depends on the duration of time before treatment is initiated. Vasodilators, anterior chamber paracentesis, and ocular massage have been used as initial treatment. Intra-arterial tPA has shown some promise as a therapeutic modality. Early Hyperbaric Oxygen Therapy may temporize the patient until the obstruction resolves spontaneously or other therapies have time to work.