Update on Acute Retinal Arterial Ischemic Disorders

Acute retinal artery occlusions present with sudden painless monocular vision loss and are homologous to cerebral ischemic strokes. The diagnosis is made on ocular fundus examination facilitated by fundus photography and optical coherence tomography. In the acute setting, patients should undergo a standard stroke evaluation, in addition to workup for possible giant cell arteritis in patients aged 50 years and older. Recent meta-analyses of observational studies have suggested a potential positive treatment effect for intravenous tPA when delivered within 4.5 hours of symptom onset. Analyses of clinical trials evaluating intravenous thrombolysis within 4.5 hours of vision loss are ongoing.