Retinal and Ophthalmic Artery Occlusions PPP 2019

By the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee: Christina J. Flaxel, MD,¹ Amani Fawzi, MD,² G. Atma Vemulakonda, MD,³ Ron A. Adelman, MD, MPH, MBA, FACS,⁴ Steven T. Bailey, MD,⁵ Jennifer I. Lim, MD,⁶ Gui-shuang Ying, MD, PhD⁷

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¹Casey Eye Institute, Oregon Health & Science University, Portland, OR

²Feinberg School of Medicine, Northwestern University, Chicago, IL 

³Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA

⁴Yale University Eye Center, New Haven, CT

⁵Casey Eye Institute, Oregon Health & Science University, Portland, OR

⁶University of Illinois at Chicago, Chicago, IL

⁷Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

Highlighted Findings and Recommendations for Care

An ophthalmic artery occlusion (OAO), central retinal artery occlusion (CRAO), or, less commonly, a branch retinal artery occlusion (BRAO) can be associated with life-threatening conditions (e.g., carotid occlusive or cardiac valve disease). In patients over 50 years of age, one must additionally suspect giant cell arteritis (GCA) and should consider urgent systemic corticosteroid therapy when GCA is diagnosed or very likely in an attempt to preserve or recover vision in the affected eye and preserve in the contralateral eye.

An OAO or retinal artery occlusion (RAO) occurring in a patient of any age should prompt a systemic evaluation for carotid occlusive and thromboembolic disease. Generally, this would be a workup for vasculitis or hypercoagulablility in younger patients (under 50 years old) and an embolic workup in older patients (over 50 years old).

Acute, symptomatic OAO or CRAO from embolic etiologies should prompt an immediate referral to the nearest stroke referral center for prompt assessment for consideration of an acute intervention. The precise timing of evaluation for patients with an asymptomatic but newly diagnosed CRAO or BRAO is unclear, though these patients still warrant a timely referral.

In general, there are no proven treatments to reverse the vision loss caused by CRAO, BRAO, or OAO.

In vascular occlusive disorders of the eye, there is an increased risk for posterior and/or anterior segment neovascularization. Patients with greater ischemia require closer and more frequent follow-up. Panretinal photocoagulation (PRP) treatment is recommended for patients who develop iris or retinal neovascularization.

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