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Acute central retinal artery obstruction

 
, medical expert
Last reviewed: 07.07.2025
 
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Occlusion of the main trunk of the central retinal artery by an embolus, thrombus, or a sharp spasm of it is clinically accompanied by sudden blindness of the corresponding eye. Ophthalmoscopic examination reveals clouding of the retina along its entire length, with the exception of the central fossa, and a sharp narrowing of the artery. In thin arterial branches (vessels of the third order), broken, stopped columns of blood are visible. The veins also narrow, but sometimes their usual width is preserved.

Acute disruption of the arterial blood circulation of the retina causes its sharp whitening due to turbidity and swelling of the interstitial substance. Only the area of the central fovea retains its usual red color, because the retina in this place is very thin and the red color of the choroid is clearly visible.

Metabolic processes in the retinal nerve cells are disrupted and may stop completely, oxygen deficiency occurs. All this leads to a rapid loss of visual functions. Only in rare cases, when there are arterial vessels connecting the central retinal artery system with the ciliary system of the choroid, can the function of the retina be preserved in a limited area, where arterial blood circulation functions due to the cilioretinal artery. The embolus usually blocks the lumen of the main trunk in the place of the artery where it is somewhat narrowed and its walls are tightly fixed (under the cribriform plate of the optic nerve). The same picture as with arterial blockage occurs due to endarteritis.

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Symptoms of acute central retinal artery occlusion

Acute obstruction of the central retinal artery is usually unilateral. In the clinic, acute obstruction conditions (embolism, thrombosis, spasm) are also observed not only of the main trunk, but also of individual branches of the artery. Then the retinal clouding is limited to the area of blood supply of this branch and the loss of the corresponding area in the field of vision. True embolism of the central artery, as a rule, has a poor prognosis: functions are not restored.

In sudden blindness, which occurs as a result of spasm of the central retinal artery, the loss of function is often short-lived. Ophthalmoscopically, the pictures are similar.

With the above pathology, atrophy of the optic nerve (primarily ascending) occurs. It develops in 2-3 weeks. Sometimes newly formed vessels appear (a sign of ischemia).

What do need to examine?

Treatment of acute obstruction of the central retinal artery

Treatment of acute obstruction of the central retinal artery is urgent and aimed at:

  • elimination of spasm - 10% caffeine solution, 0.1% atropine solution subcutaneously, inhalation of amyl nitrate, nitroglycerin, papaverine, no-shpa, 1% nicotinic acid solution intravenously, cardiac glycosides such as strophanthin, digitalis (since antispasmodics lower blood pressure, as a result of which blood flow slows down and secondary thrombosis can occur), complamine intramuscularly, intravenously (dilates blood vessels and improves heart function), cavinton intravenously; friscol intravenously, orally;
  • impact on the internal vessels of the thrombus - urokinase (20-40 thousand U intravenously), fibrolysin; direct and indirect anticoagulants (heparin, phenylin);
  • reduction of blood viscosity - intravenous trental (aspirin, papaverine, diphenhydramine);
  • if there is vascular obstruction, angiitis, then corticosteroids are prescribed;
  • in the early period - laser coagulation. Against the background of edematous retina, coagulants that break through the pigment
  • epithelium, form new pathways for the outflow of edema fluid into the vascular membrane;
  • symptomatic treatment - angioprotectors, biogenic stimulants.

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