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Central and branch retinal artery occlusion

Author
Thomas R Hedges, III, MD
Section Editors
Paul W Brazis, MD
Jonathan Trobe, MD
Deputy Editor
Janet L Wilterdink, MD

INTRODUCTION

Central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO) present with acute, painless loss of monocular vision. These disorders are considered a form of stroke, with a similar clinical approach and management; the clinician attempts to treat the acute event, find the source of the vascular occlusion, and prevent further vascular events from occurring.

Issues related to central and branch retinal artery occlusion will be reviewed here. Other ocular ischemic syndromes are discussed separately. (See "Amaurosis fugax (transient monocular or binocular visual loss)".)

VASCULAR ANATOMY

Blood flowing to the retina travels through blood vessels that are subject to varying environments and external pressures [1]. The central retinal artery arises from the ophthalmic artery, itself a branch of the internal carotid artery. The ophthalmic artery departs from the intracranial portion of the carotid artery at a sharp angle, after which it travels intracranially for a short distance before entering the orbit, usually with the optic nerve. Once entering the orbit, the central retinal artery leaves the ophthalmic artery to enter the cerebral spinal fluid space and then travel within the optic nerve, after which it enters the eye, where it is subjected to intraocular pressure.

The central retinal artery supplies the inner retina and the surface of the optic nerve. In about 15 percent of individuals, it is assisted by a branch of the ciliary circulation, the cilioretinal artery, which may supply a portion of the retina, including the macula. This allows for preservation of vision in some patients with central retinal artery occlusion.

The physiology of central retinal artery function is poorly understood, but it is primarily autoregulated [2]. This means that under a range of systemic mean arterial pressures, ocular blood flow remains constant. (See "Moderate to severe hypertensive retinopathy and hypertensive encephalopathy in adults", section on 'Mechanisms of vascular injury'.)

                        

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Literature review current through: Nov 2016. | This topic last updated: Wed May 08 00:00:00 GMT+00:00 2013.
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