Acute retinal artery occlusions

Acute retinal artery occlusions present with sudden, painless monocular vision loss and are equivalent to cerebral strokes. The diagnosis is made on ocular fundus examination facilitated by fundus photography and optical coherence tomography. Management of acute retinal artery ischemia requires a collaborative approach among emergency department, ophthalmology, and stroke neurology providers. In the acute setting, patients should undergo a standard stroke evaluation. There are currently no widely accepted therapies for acute retinal artery occlusions. So-called "conservative treatments," such as anterior chamber paracentesis, ocular massage, and hemodilution, have no benefit and should not be pursued. Recent meta-analyses and reviews from experts have suggested a possible treatment effect for intravenous tPA within 4.5hours of vision loss or intra-arterial tPA within 6hours of vision loss for patients with acute central retinal artery occlusion. Ongoing clinical trials evaluating intravenous thrombolysis within 4.5hours of vision loss will hopefully provide definite answers. In the interim, it is essential to educate providers and patients about the importance of calling emergency services when experiencing acute vision loss to ensure immediate transfer to a facility affiliated with a stroke center, where timely diagnosis, evaluation, and treatment of acute retinal ischemia can occur.