Challenging the diagnosis and treatment of central retinal artery occlusion (CRAO) in emergency department

Abstract

Central retinal artery occlusion (CRAO) is an occlusion of the central retinal artery that causes a disruption of blood flow to the retina and may result in retinal ischemia. According to the American Heart Association/American Stroke Association (AHA/ASA), CRAO is a type of acute ischemic stroke. There is some variation in CRAO management. Determining the most effective therapy remains challenging. We report a male, 58th-years-old, with sudden vision loss in the right eye for 4 hours of onset upon arrival at the Emergency Department. Patient aware, with hypertensive crisis, the right eye visual acuity was 1/300. Brain Magnetic Resonance Imaging (MRI) revealed multiple small vessel ischemic in the cortical-subcortical area. The patient was hospitalized and received ocular massage, antiplatelet, antihypertensive, and lipid-lowering therapy. Visual acuity in the right eye was minimally improved at discharge. CRAO is a form of stroke in the retina and may occur concurrently or progress into cerebral ischemia. Treatment with intravenous thrombolysis may be effective within 4.5 hours of onset. Ensuring the patient arrives at the emergency department and confirming the diagnosis of CRAO in this narrow time is still challenging.