Retinal and Ophthalmic Artery Occlusions

Publication Date: September 20, 2019

HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE

An ophthalmic artery occlusion (OAO), central retinal artery occlusion (CRAO), or, less commonly, a branch retinal artery occlusion (BRAO) can be associated with life-threatening conditions (e.g., carotid occlusive or cardiac valve disease). In patients over 50 years of age, one must additionally suspect giant cell arteritis (GCA) and should consider urgent systemic corticosteroid therapy when GCA is diagnosed or very likely in an attempt to preserve or recover vision in the affected eye and preserve in the contralateral eye.
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An OAO or retinal artery occlusion (RAO) occurring in a patient of any age should prompt a systemic evaluation for carotid occlusive and thromboembolic disease. Generally, this would be a workup for vasculitis or hypercoagulablility in younger patients (under 50 years old) and an embolic workup in older patients (over 50 years old). (, , )
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Acute, symptomatic OAO, CRAO, or BRAO from embolic etiologies should prompt an immediate referral to the nearest stroke referral center for prompt assessment for consideration of an acute intervention. The precise timing of evaluation for patients with an asymptomatic but newly diagnosed CRAO or BRAO is unclear, though these patients still warrant a timely referral.
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In general, there are no proven treatments to reverse the vision loss caused by CRAO, BRAO, or OAO.
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In vascular occlusive disorders of the eye, there is an increased risk for posterior and/or anterior segment neovascularization. Patients with greater ischemia require closer and more frequent follow-up. Panretinal photocoagulation (PRP) treatment is recommended for patients who develop iris or retinal neovascularization.
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Overview

Title

Retinal and Ophthalmic Artery Occlusions

Authoring Organization

Publication Month/Year

September 20, 2019

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Identify patients at risk for developing RAO. Reduce the risk of severe ocular consequences or systemic conditions. Optimize RAO risk factors, including smoking cessation, systemic blood pressure, and diabetes as well as other systemic risk factors. Monitor for signs of retinal or anterior segment angiogenesis that lead to further complications, such as vitreous hemorrhage or neovascular glaucoma. Provide or refer for visual rehabilitation services when a patient has visual impairment from the disease.
 

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Optometrist, optician, nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Management

Diseases/Conditions (MeSH)

D015356 - Retinal Artery Occlusion, D005901 - Glaucoma

Keywords

vision loss, ophthalmic occlusions, retinal artery

Source Citation

Flaxel, C. J., Adelman, R. A., Bailey, S. T., Fawzi, A., Lim, J. I., Vemulakonda, G. A., & Ying, G. (2019). Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern®. Ophthalmology. doi:10.1016/j.ophtha.2019.09.028

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
82
Literature Search Start Date
April 1, 2018
Literature Search End Date
June 1, 2019