Treatment of central retinal artery occlusions.

• Making the correct ophthalmic diagnosis Acute visual loss is when the known duration of visual loss is short, to be distinguished from when the patient accidentally discovers a longer-standing visual loss. The elderly patient (the group most affected by CRAO), is frequently unaware of the loss of vision in one eye, until they happen to close the other eye (i.e., a foreign body in the “good” eye). They date the loss of vision to the time they closed the eye with better vision. The patient is then seen as an emergency with “acute” visual loss, but retinal examination reveals the visual loss to be long-standing. The “acuteness” or “chronicity” of visual loss may be difficult to assess without ophthalmic examination experience. It may also be difficult to perform a retinal examination through a miotic, undilated pupil in an elderly patient with cataracts in the emergency room setting. Many conditions associated with visual loss also exhibit cotton-wool spots (soft exudates) which may be mistaken for the retinal edema seen in arteriolar occlusion. The differential diagnosis includes: pre-proliferative diabetic retinopathy with macular edema; epimacular membrane and vitreomacular traction (the whitish posterior pole sheen may simulate retinal edema); shallow retinal detachment; retinoschisis (a splitting of the retina) extending into the posterior pole; commotio retinae (caused by an ocular contusion); Purtscher’s retinopathy (from a crush injury), malignant hypertension, collagen diseases, hematologic conditions, Hodgkin’s disease, infective conditions, etc. Treatment of central retinal artery occlusions