Retinal Artery Occlusion

Retinal Artery Occlusion

Occlusion of retinal arterioles in the form of a branch retinal artery occlusion (BRAO) or central retinal artery occlusion (CRAO) may be a precursor to further visual loss, stroke, or death.


The causes of retinal artery occlusion may be embolic or thrombotic. Different etiologies are more prevalent in different age groups. For example, in the vasculopathic age group (over 50 years of age), carotid atheroma is a more likely cause than it would be in a younger population. In the younger age group, hyperviscosity syndromes, vasculitis, or cardiac abnormalities tend to be more frequent causes.

There are several types of retinal emboli:

• Platelet-fibrin emboli: These appear as nonrefractile white or gray emboli usually seen in the distal arterioles. The source of the emboli is thrombotic (carotid or aortic arch atheroma), cardiac, or cardiac prosthesis.

• Cholesterol: These are often multiple yellow, refractile emboli often located at the arterial bifurcation (Fig. 4-1). They suggest an atheroma in the ipsilateral carotid artery or aortic arch.

• Calcium: These are usually isolated, large white emboli located in the proximal segment of the central retinal artery or its branches. They suggest calcified atheromatous plaque or cardiac valve (Fig. 4-2).

• Other

  • Fat: It appears as multiple whitish spots associated with hemorrhages and/or cotton wool infarcts. They occur most frequently with damage/injury to long bones.

  • Talc: These multiple yellow refractile emboli are associated with intravenous drug use.

  • Infectious: Multiple white spots (Roth spots) suggest underlying infectious endocarditis.

  • Neoplasm: Cardiac myxoma may produce multiple white gray emboli.

FIGURE 4-1. A bright plaque that appears larger than the artery in which it resides is seen at a retinal arteriole bifurcation. This glistening appearance suggests a cholesterol embolus of carotid artery origin.

FIGURE 4-2. A. Hour-glass-shaped embolus lodged in the inferior temporal artery OS with adjacent retinal whitening. B.The following day the patient presented with decreased vision OD with multiple large white emboli (not present the previous day) at the optic disc with retinal whitening.


Jul 14, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on Retinal Artery Occlusion

Full access? Get Clinical Tree

Get Clinical Tree app for offline access