What are the recommended emergency management strategies for a patient

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Central Retinal Artery Occlusion (CRAO) is considered a medical emergency requiring urgent management to prevent permanent visual loss , ().

Immediate Actions and Referral:

Arrange an urgent (same day) assessment by an ophthalmologist .
Consider Giant Cell Arteritis (GCA) as a potential underlying cause, especially if there is new visual loss (transient or permanent) or double vision .
If GCA is strongly suspected, immediate treatment with high-dose glucocorticoids is necessary . A specialist may advise a one-off high-dose corticosteroid treatment in primary care while the patient awaits transfer to ophthalmology . For acute or intermittent visual loss due to GCA, intravenous glucocorticoid therapy is usually given; if not possible, 60–100 mg oral prednisolone may be administered for up to 3 consecutive days .

Emergency Interventions (typically in secondary care):

Strategies aim to restore retinal blood flow and may include ocular massage, anterior chamber paracentesis, and the administration of vasodilators ().
Intravenous thrombolysis may be considered in selected cases, particularly within a narrow time window from the onset of symptoms (, ).
Antithrombotic therapy may also be used in the management of retinal artery occlusion ().

What are the recommended emergency management strategies for a patient presenting with CRAO?