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

Central Retinal Artery Occlusion (CRAO) is considered a medical emergency requiring urgent management to prevent permanent visual loss ⁴, ((Mac Grory et al., 2021)).

Immediate Actions and Referral:

• Arrange an urgent (same day) assessment by an ophthalmologist ⁴.
• Consider Giant Cell Arteritis (GCA) as a potential underlying cause, especially if there is new visual loss (transient or permanent) or double vision ⁴.
• If GCA is strongly suspected, immediate treatment with high-dose glucocorticoids is necessary ⁴. A specialist may advise a one-off high-dose corticosteroid treatment in primary care while the patient awaits transfer to ophthalmology ⁴. 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 ⁴.

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 ((Roskal-Wałek et al., 2024)).
• Intravenous thrombolysis may be considered in selected cases, particularly within a narrow time window from the onset of symptoms ((Mac Grory et al., 2021), (Roskal-Wałek et al., 2024)).
• Antithrombotic therapy may also be used in the management of retinal artery occlusion ((Liu et al., 2025)).