Treatment of Central Retinal Artery Occlusion — Nonarteritic (Embolic) Type Without Giant Cell Arteritis
Clinical Scenario
This protocol applies to central retinal artery occlusion (CRAO) of nonarteritic, embolic origin in patients without evidence of giant cell arteritis (GCA). Differentiating this presentation from the arteritic form is essential, as the two entities carry distinct causes and management considerations.
About This Presentation
Most nonarteritic retinal artery occlusions are embolic in origin, in contrast to the arteritic form, which is caused by GCA. In the nonarteritic embolic group, evidence for proven treatments is limited, making rapid specialist evaluation a priority.
Approach Overview
Acute management prioritises immediate referral to an emergency department at a stroke-affiliated centre for comprehensive medical evaluation. Antifibrinolytic therapy is among the interventions that may be considered in eligible acute presentations.
Full regimen, patient selection criteria, and decision algorithm available in the complete protocol →
References
- Arteritic retinal arterial occlusion is caused by giant cell arteritis (GCA), whereas most nonarteritic RAOs are embolic in origin.
- In general, there are no proven therapies or treatments for symptomatic nonarteritic RAOs.
- Immediate referral to an emergency department affiliated with a stroke center for a medical evaluation is advised.
- Although the American Heart Association states that intravenous or intra-arterial antifibrinolytic therapy can be "considered" for acute CRAO if within 4.5 and 6 hours from symptom onset, respectively, at this point there is insufficient evidence to definitively know if thrombolysis leads to better visual outcomes.
DOI: 10.1016/j.ophtha.2024.12.024
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