Acute Central Retinal Artery Occlusion

Objectives
Diagnosis
Criteria for HBO therapy
Work-up considerations
Treatment
Suggested treatment threshold
ICD 10 codes
Level of evidence

Objectives

To support retinal oxygenation. To prevent or reduce retinal edema as well as ischemia-reperfusion injury, if clot undergoes autolysis.

Diagnosis

History of sudden painless loss of monocular vision. Fundoscopic findings include whitening of the superficial retina in the posterior pole. A cherry red spot may develop in the area of the macula, secondary to choroidal perfusion.

Criteria for HBO therapy

If high index of suspicion of acute CRAO, treatment should be initiated as soon as possible WITHIN 24 HOURS OF SYMPTOMS ONSET. Presumptive diagnosis should be confirmed by ophthalmologist but not delay treatment.

Work-up considerations

1. Presumptive diagnosis should be confirmed by ophthalmologist but not delay treatment
2. Medical history & physical examination, including visual acuity
3. CXR where indicated; order or review. Discuss with HBO consultant if unsure.
4. Signed informed consent for HBOT

Treatment

1. Administer Oxygen immediately at the highest possible FiO₂.
   1. If good response and HBO not necessary, treat on 100% oxygen with non-rebreather for 12 hours and titrate off as tolerated.
2. If no response within 5 minutes, refer for HBOT.
3. HBO at 2 - 2.4 ATA for 90 minutes with two 5 – 10 minute air breaks.
4. If vision improves, treat at 2 - 2.4 ATA for 90minutes BID for 3 days.
5. If no evidence of improvement, abort further HBOT.

Suggested treatment threshold

2 – 5 treatments

ICD 10 codes

Level of evidence

Level C