By /khaled wael elsayed

ID/397
 first described as an embolic occlusion of the
CRA in a patient with endocarditis by von
Graefe in 1859 .
 It is estimated that around 1.9/100,000 in
the United States have retinal stroke .
 The most common cause of
CRAO is thrombo-embolus,
which occurs at the narrowest
part of the central retinal
artery, where it pierces the
dural sheath of the optic nerve .
 occlusive thrombus at the level
immediately posterior to the
lamina cribrosa
 Vasospasm
 Arteritis
 Central retinal vein occlusion
 Non-arteritic permanent CRAO
 Non-arteritic transient CRAO
 Non-arteritic CRAO with cilioretinal sparing
 Arteritic CRAO
 Non-arteritic permanent  Non-arteritic transient
CRAO CRAO
 Non-arteritic CRAO with  Arteritic CRAO
cilioretinal sparing
 an acute, painless loss of vision
 80 % of affected patients have a final visual acuity of
counting fingers or worse .
 Approximately 15–30 % of the general population have a
cilioretinal artery,It supplies a part or the whole of the
fovea, and in those eyes where there is a CRAO, the
cilioretinal artery is spared and the visual acuity may be
preserved at 20/50 or better, with loss of peripheral vision
only
 Patients who have giant cell arteritis are 55 or older and
may have a headache, a painful temporal artery, jaw
claudication, fatigue, or a combination.
 Light reflex
The pupil may respond poorly to direct light
but constricts briskly when the other eye
is illuminated (relative afferent pupillary defect).
 funduscopy
In acute cases, shows a pale, opaque fundus with
a red fovea (cherry-red spot).Typically,
the arteries are attenuated and may
even appear bloodless. An embolus
(eg, a cholesterol embolus, called a Hollenhorst plaque) is sometimes
visible. If a major branch is occluded rather than the entire artery,
 vision loss are limited to that sector of the retina.
 Diet& lifestyle
 Pharmacological treatment (1st 6 hours )
A-vasodilators
b-occular massage and drugs ( reduce IOP )
c-iv corticosteroids
D-thromolytic drugs
 Surgical treatment
A-YAG laser embolyectomy
B-Anterior chamber paracentesis