Suspected CRAO
Sudden, painless, monocular vision loss. Cherry-red spot, pallid retina, box-carring vessels on fundoscopy
All Pathways
OphthalmologyEmergency
Central Retinal Artery Occlusion (CRAO) Management
Central Retinal Artery Occlusion (CRAO) Management: Suspected CRAO → Symptom Onset <24 hours? → Activate Stroke Alert → Patient Age ≥50 years? → GCA Wor...
Pathway Overview
11 steps
Algorithm Steps
11 total
01Start 02Decision Symptom Onset <24 hours?
CRAO is a stroke equivalent. Irreversible retinal ischemia can occur in as little as 90 minutes
03Action Activate Stroke Alert
CRAO = CNS infarction per AHA/ASA. Immediate referral to nearest stroke center for evaluation of acute intervention
- Call stroke team/code stroke
- Do NOT delay for ophthalmology workup
- Stroke risk highest in first 2 weeks to 1 month
04Decision Patient Age ≥50 years?
Giant cell arteritis (GCA) must be ruled out in older patients
05Action GCA Workup
URGENT: Rule out giant cell arteritis to prevent contralateral vision loss
- Check ESR, CRP immediately
- Ask about headache, jaw claudication, scalp tenderness, PMR symptoms
- If GCA suspected: start IV methylprednisolone 1g/day BEFORE biopsy
- Arrange temporal artery biopsy within 2 weeks
06Action Systemic Stroke Evaluation
Look for embolic source - carotid disease, cardiac source
- Carotid ultrasound/CTA
- Echocardiogram (TTE ± TEE)
- ECG/Holter for AF
- CBC, lipids, HbA1c, coagulation
- Consider hypercoagulability panel if <50 years
07Warning ⚠️ Monitor for Neovascularization
Increased risk of iris/retinal neovascularization after CRAO
- Follow-up examination in 1-2 weeks
- More frequent follow-up if greater ischemia
- PRP if neovascularization develops
08Action Secondary Stroke Prevention
Address modifiable risk factors to prevent future events
- Antiplatelet therapy (aspirin)
- Statin therapy
- Blood pressure control
- Diabetes management
- Smoking cessation
- Carotid endarterectomy if significant stenosis
09Outcome Acute Management Complete
Patient evaluated by stroke team. Etiology identified. Prevention measures initiated
10Outcome Retina Follow-up
Schedule retina clinic follow-up for neovascularization monitoring and visual rehabilitation
- Path rejoins step 06Shared downstream outcome
11Action Late Presentation (>24h)
No proven treatments to reverse established vision loss. Focus on stroke prevention and etiology workup
- Path rejoins step 04Shared downstream outcome
Guideline Source
AAO Preferred Practice Pattern: Retinal and Ophthalmic Artery Occlusions 2024
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address branch retinal artery occlusion (BRAO) specifically
- Treatment decisions for thrombolysis should involve stroke neurology
- Pediatric and young adult CRAO requires additional hypercoagulability workup
- Does not replace comprehensive stroke center evaluation
Applicable Regions
USEUGlobal
EU: Follow local stroke network protocols
US: AHA/ASA classify CRAO as CNS stroke - refer to stroke center
Version 1Next review: 2029-01-01
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Related Resources
Frequently Asked Questions
What is the Central Retinal Artery Occlusion (CRAO) Management?
The Central Retinal Artery Occlusion (CRAO) Management is a emergency clinical algorithm for Ophthalmology. It provides a structured decision tree to guide clinical decision-making, based on AAO Preferred Practice Pattern: Retinal and Ophthalmic Artery Occlusions 2024.
What guideline is the Central Retinal Artery Occlusion (CRAO) Management based on?
This algorithm is based on AAO Preferred Practice Pattern: Retinal and Ophthalmic Artery Occlusions 2024 (DOI: 10.1016/j.ophtha.2024.12.024).
What are the limitations of the Central Retinal Artery Occlusion (CRAO) Management?
Known limitations include: Does not address branch retinal artery occlusion (BRAO) specifically; Treatment decisions for thrombolysis should involve stroke neurology; Pediatric and young adult CRAO requires additional hypercoagulability workup; Does not replace comprehensive stroke center evaluation. Individual patient factors may require deviation from these recommendations.
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