What is central retinal artery occlusion?
The retina is the light-sensitive layer at the back of the eye that is responsible for vision. Blood circulation to most of the retina’s surface is primarily through one artery and one vein. If either blood vessel or one of their smaller branches is blocked, blood circulation to the retina can be significantly disrupted. The blockage is called an occlusion.
If a main vessel becomes occluded, the eye typically loses vision, often suddenly. If blockage occurs in a smaller branch vessel, there may be partial vision loss or no symptoms. The condition is often painless.
How common is central retinal artery occlusion?
Men are affected slightly more frequently than women. Some few cases have been reported in patients younger than 30 years. The etiology of occlusion changes depending on the age.
However, it can be managed by reducing your risk factors. Please discuss with your doctor for further information.
What are the symptoms of central retinal artery occlusion?
The usual symptom of central retinal artery occlusion is a sudden, painless, persistent, substantial loss of vision in one eye. In about 10% of those affected, this loss of vision is preceded by one or more episodes of a condition called amaurosis fugax. Amaurosis fugax is a temporary episode of decreased vision, usually lasting no more than 10 to 15 minutes, that is sometimes described as “closing a curtain” on one eye.
Also, depending on the extent of retinal damage, some people have only minimal blurring of vision, while others have more substantial vision loss.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consulting with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes central retinal artery occlusion?
The main cause of central retinal artery occlusion is atherosclerosis. Atherosclerosis is a problem with the condition of the inside of the blood vessel’s wall. Blood vessels are like tubes with the blood flowing smoothly through them. Atherosclerosis is a problem with the inside of the tube. The tube is usually wide and smooth so that the blood flows directly through it.
However in some people the inside of this tube becomes narrower or sticky which means it is harder for the blood to flow through it. These patches of stickiness on the inside of the blood vessels are called atherosclerotic plaques or sometimes hardening or thinning of the arteries.
If you have sticky patches in your blood vessels they can catch any debris in your blood which in turn makes the plaques bigger. Eventually these plaques can become large enough to cut off part or all of the blood going to or from your retina. Large pieces of debris can also get caught and block off the blood vessel completely. If your retinal blood supply is affected in this way then you will have a retinal artery occlusion.
What increases my risk for central retinal artery occlusion?
There are a number of risk factors for thinning of arteries which may lead to retinal vessel occlusion:
- Age – most retinal vessel occlusions happen in people over 65
- High blood pressure
- High cholesterol levels
- Being overweight
Nothing can be done about age but all the other risk factors can be controlled. Your doctor can diagnose any circulation problems like high blood pressure and cholesterol levels and prescribe any medication to help control them. If you are diabetic then good diabetic control can help reduce the risk of blood vessel problems. A healthy diet and stopping smoking can all help to reduce the risk of you experiencing a retinal vessel occlusion. Your doctor can give you advice on maintaining a healthy weight and stopping smoking.
Diagnosis & Treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is central retinal artery occlusion diagnosed?
After reviewing your symptoms, the doctor will ask questions about your medical history, especially any history of high blood pressure, heart disease, diabetes, glaucoma, eye trauma or amaurosis fugax. Next, your doctor will do a thorough eye examination, including tests of your visual acuity (how well you can see) and peripheral vision. Your doctor will use special eyedrops to dilate (open wide) your pupils to examine the inside of your eye, including the retina.
During this examination, the doctor will use an instrument called an ophthalmoscope to see whether your retina’s blood supply appears to be normal, or whether there are areas of whiteness (a sign of arterial occlusion), hemorrhage, a visible embolus lodged in a retinal vessel, or other problems. In some cases, the doctor also may order fluorescein angiography, a test that uses an injected dye to analyze blood flow in the eye.
In addition, if the doctor suspects that your eye problem is being caused by emboli from undiagnosed cardiovascular illness, you may need diagnostic tests to evaluate the blood flow in your heart and carotid arteries. Also, blood tests may be necessary to determine your cholesterol levels or to check for blood clotting disorders, especially in very young people.
How is central retinal artery occlusion treated?
Central retinal artery occlusion is a medical emergency. Treatment focuses on increasing blood flow to the retina as soon as possible. However, none of the therapies have proven to be best and results are frequently disappointing. Options include:
- Injecting a clot buster – The doctor injects a drug called a thrombolytic directly into the retinal artery near the site of occlusion.
- Anterior chamber paracentesis – An eye specialist uses a needle to remove a few drops of fluid from inside your eye. This decreases the pressure within your eye, making it easier for blood to flow through your retinal artery.
- Ocular massage – The doctor uses his or her finger to apply pressure to your eye through your closed eyelid. The hope is that this can dislodge an embolus or thrombus.
- Vasodilator medication – Drugs such as nitroglycerin, isosorbide and pentoxifylline may be given to help improve blood flow.
- Breathing carbogen – By breathing this mixture of 95% oxygen and 5% carbon dioxide, you may be able to increase the flow of blood and oxygen to your retina.
- Rebreathing carbon dioxide – If carbogen is not available, the doctor may ask you to breathe into a paper bag to increase the amount of carbon dioxide in your blood. The increased level of carbon dioxide might dilate (widen) the arteries in your retina, increasing blood flow.
- When central retinal artery occlusion is caused by temporal arteritis, doctors prescribe high dose corticosteroids. The dose is gradually tapered over many months.
Lifestyle changes & Home remedies
What are some lifestyle changes or home remedies that can help me manage central retinal artery occlusion?
Since many cases of central retinal vessel occlusion are related to high blood pressure, atherosclerosis or diabetes, it may be possible to prevent this eye problem by not smoking and controlling your blood pressure, cholesterol level and blood sugar. Also, people with diabetes should have a thorough eye examination through dilated pupils at least once a year.
To help prevent central retinal artery occlusion related to traumatic eye injuries, always wear appropriate protective eye gear (goggles, face shield, face mask) at work and while playing sports. Also, remember to use a seat belt whenever you ride in a car to prevent your face and eyes from hitting the dashboard during a collision.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: February 19, 2017 | Last Modified: December 4, 2019
Central retinal artery occlusion. http://www.rnib.org.uk/eye-health-eye-conditions-z-eye-conditions/retinal-vessel-occlusion. Accessed 19 Feb, 2017.
Central retinal artery occlusion. https://en.wikipedia.org/wiki/Central_retinal_artery_occlusion. Accessed 19 Feb, 2017.
Central retinal artery occlusion. http://eyewiki.aao.org/Retinal_Artery_Occlusion. Accessed 19 Feb, 2017.