Central Retinal Artery Occlusion: Pathogenesis and clinical findings

 • Inflammatory Disease: (i.e. GCA, SLE, GPA) -> Endothelial cell damage creates hypercoagulable state

 • Cardiogenic Embolism: (i.e. Valvular, arrhythmias, congenital defects) -> Abnormal blood flow causing localized stasis

 • Hypercoagulable state: (i.e. OCP, Protein C & S deficiency, ATIII deficiency) -> Increased coagulation and/or decreased anti-coagulation

 • Hematologic Disease: (i.e. leukemia/lymphoma, sickle cell, polycythemia) -> Increased blood viscosity and inflammation

 • Carotid Artery Atherosclerosis -> Atherosclerotic plaque dislodges from carotid artery

=> Blockage of central retinal artery

=> Central Retinal Artery Occlusion (CRAO)

 • The retina becomes pale from perfusion  -> The choroidal vessels supplying the macula via the posterior ciliary artery become more prominent within a background of retinal pallor -> Cherry-red spot

 • Decreased perfusion of retinal arterioles due to upstream CRAO -> Arteriole narrowing

 • Slow retinal artery blood flow allows for segmentation of the blood column -> "Box-carring" or "cattle trucking"

 • Acute retinal edema caused by ischemia results in a blurred appearance of the retina -> Ground Glass Retina

 • Ganglion cells and axons death due to ischemia results in disc pallor seen months after CRAO -> Pale Optic Disc -> Decreased Visual Acuity



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