CENTRAL RETINAL ARTERY OCCLUSION (CRAO) - It occurs when a severe, abrupt diminution of blood flow through the central retinal artery causes ischemia of the inner retina - Ophthalmic artery is the first intracranial branch of internal carotid artery. Supplies blood to eyes via: 1. Central retinal artery supplies inner retina 2. Ciliary branchessupplies choroid and anterior portion of globe - Emboli can travel to more distal branches causing loss of only a section of visual field - Commonly associated with amaurosis fugax - Visual acquity typically 20/800 (6/240) or worse - Fundoscopy: diffuse ischemic retinal whitening, pale optic disc, cherry red fovea (typical but not specific) and boxcar segmentation of blood in retinal veins - Ophthalmic emergency—delay in Rx can lead to permanent vision loss - Rx: Immediate intervention: ocular massage—dislodges embolus to more distal branch and improves vision—most rapid Medical management and anterior chamber paracentesis to lower IOP—may be used Carbogen therapy (5% CO2 and 95% O2) or hyperbaric oxygen—beneficial if given early Thrombolytic therapy may be helpful if given in 4-6 hours—given intraarterially—efficacy not systematically studied