Central Retinal Artery Occlusion

With an incidence of about 1 in 10,000 people, central retinal artery occlusion is generally not the result of trauma. Risk factors include atrial fibrillation, mitral valve disease, atherosclerosis, a hypercoagulable state, and hypertension. Additionally, prolonged intraorbital swelling can cause occlusion of the central retinal artery. Such situations occur particularly in patients who are having surgery in the face-down position. The characteristic fundus appearance with central retinal artery occlusion is narrow arterioles and a pale optic disc. In addition, there is diffuse retinal whitening. A cherry-red spot occurs only several hours after the initial retinal artery occlusion (Fig. 41-10).

Treatment of central retinal artery occlusion must be immediate, including breathing into a small paper bag to help increase the patient's carbon dioxide level. Emergency paracentesis is a rapid method to decompress the eye and may actually provide immediate restoration of vision. However, most physicians are reluctant to perform paracentesis on a patient within a few minutes. Ocular massage is another means of decompressing the eye. Some centers have hyper-baric oxygen available, which may also be helpful in restoring retinal perfusion for some patients. Treatment should be instituted within 90 minutes if any realistic hope of possible visual recovery can be expected. Patients with central retinal artery occlusion should be thoroughly evaluated for cardiac and carotid disease.

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