Central Retinal Artery Occlusion – April, 2026
History:
A 91-year-old patient presented with sudden onset right eye vision loss of 2 days. The patient reported only a “spot” remaining in the right eye vision with no issues of the left eye. No recent surgery or trauma.
Exam:
Visual acuity OD was 20/30 and OS was 20/25. Intraocular pressure was normal in both eyes (OU). Anterior segment was unremarkable apart from PCIOL OU. Posterior segment OD revealed 0.2 CDR, posterior vitreous detachment, arteriovenous nicking, mild epiretinal membrane, superior retinal whitening in the macula, prior retinal tear laser scarring but otherwise attached. Macula OCT OD showed superior inner retinal hyper-reflectivity and edema (Fig 1). Right eye fluorescein angiogram revealed significantly delayed AV transit time and extensive non-perfusion with area of sparing in the central macula in the late phase of 5 minutes (Fig 2).
Differential Diagnosis of Central Retinal Artery Occlusion:
• Embolic
• Hypertensive arterial necrosis
• Dissecting aneurysm within the central retinal artery
• Inflammatory (i.e. giant cell arteritis)
• Vasospasm
Discussion:
Central Retinal Artery Occlusion:
Central retinal artery occlusion (CRAO) is due to acute blockage of blood flow supplying the central retinal artery leading to significant vision loss. This patient sustained a CRAO with cilioretinal artery sparing, allowing perfusion of the central macula. 15-25% of people have a cilioretinal artery supplying significant macular collateral circulation. This allows for less severe central vision loss when spared in a CRAO. Cilioretinal arteries arise from short posterior ciliary arteries directly from the ophthalmic artery and not from the central retinal artery. When spared in CRAO, central vision may be maintained despite drastic visual field reduction. Cilioretinal artery sparing is an important distinction and reason the visual acuity may be normal despite significant acute vision loss. As standard of care, this patient was sent to the emergency room for a full stroke workup.
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References:
- Tripathy K, Shah SS, Waymack JR. Central Retinal Artery Occlusion. [Updated 2024 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470354/.