Eye StrokesCRVO, CRAO, BRVO, and BRAO

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Last updated 4/15/2024
Dr. P explains CRAO (also known as an eye stroke)

What is an eye stroke? 

An eye stroke or anterior ischemic optic neuropathy is a dangerous and debilitating condition resulting from a lack of sufficient blood flow to the tissue in the front part of the eye's optic nerve.

 

An eye stroke occurs when blood flow to the retina is interrupted due to a blockage. The blockage can be caused by a few things like plaque or even an infection in another part of the body. If the blood flow to the retina gets blocked, it robs the retinal cells of oxygen, and they begin to die off. This can result in blurred vision and permanent vision loss.

 

Immediate treatment is essential to prevent permanent vision damage and loss since the retina can only survive four to six hours.

What are the symptoms of an eye stroke?

 

The hallmark symptom of central retinal artery occlusion (CRAO) is a sudden change in sight. It's important to note that these symptoms typically occur suddenly, almost always in one eye, and without any accompanying pain.

 

Symptoms include:

  • Flashes and floaters
  • Distorted or blurry vision
  • Blind or dark spots
  • Vision changes that start off slight, but worsen over time.

 

What causes eye strokes?

The blockage from an eye stroke occurs with plaque build-up or even an infection in the eye or another body part, like the heart or other arteries. This blockage is known as an embolism. According to the American Academy of Ophthalmology, men are at a higher risk of having an eye stroke than women. 

 

Risk factors for eye stroke are similar to the risk factors in having a stroke in general, including:

  • High blood pressure (hypertension)
  • Diabetes
  • Smoking
  • Glaucoma
  • High cholesterol (hyperlipidemia)
  • Heart disease-plaque build-up in the blood vessels (Atherosclerosis)
  • Individuals with a history of blood clots, migraines.
  • Surviving a previous stroke
  • Though uncommon, studies have shown that those with severe COVID can also develop eye strokes.

 

Schedule your consultation today with the internationally recognized doctors at Assil Gaur Eye Institute

 

How are eye strokes diagnosed?

Diagnosing an eye stroke typically involves a combination of the following:

 

Comprehensive eye exam

Your doctor will review your medical history, then begin an eye examination, an ophthalmologist will evaluate your visual acuity, examine the structures of the eye, and assess the blood flow to the retina. They may use instruments like a slit lamp, fundoscopy (ophthalmoscopy), or retinal camera to examine the back of the eye. 

 

Imaging tests

Imaging tests are performed to confirm the diagnosis and evaluate the extent of the blockage. One common imaging technique is fluorescein angiography, where a special dye is injected into a vein in your arm, and photographs are taken as the dye flows through the blood vessels in the retina. This test helps to identify areas of blockage or leakage.

 

Optical coherence tomography (OCT) is another imaging tool that uses light waves to create detailed cross-sectional images of the retina. It also provides information about the thickness of the retina and identifies any swelling or damage.

 

Blood work

In some cases, additional tests may be ordered, such as blood tests to assess for underlying conditions like diabetes or high cholesterol or imaging of the carotid arteries to check for blockages that may have contributed to the eye stroke.

 

Is there treatment for eye strokes? 

If you experience sudden vision loss or other symptoms of an eye stroke, it is crucial to seek immediate medical attention. Time is of the essence, and prompt evaluation is necessary to determine the best course of treatment.

 

The treatment for eye strokes, specifically retinal artery occlusion (CRAO), depends on the underlying cause and the timing of presentation. Some potential treatment options include:

 

Ocular massage

In some situations, a healthcare professional may perform a gentle massage of the affected eye to potentially dislodge an embolus and restore blood flow.

 

Hyperbaric Oxygen Therapy 

This painless therapy involves breathing pure oxygen in a special chamber. The increased oxygen aids in preserving the energy supply of the retina

 

Medication 

Medication may be used to dissolve the blood clot or reduce eye pressure.

 

The most important part of the treatment is an immediate stroke-protocol workup, and patients are typically referred to the Emergency Room for a full evaluation of the heart, ultrasound of the carotid arteries in the neck as a possible emboli source, and urgent assessment of all stroke risk factors.

 

Eye strokes can increase your risk of a brain stroke. Patients will likely need long-term follow-up care to treat the problems (such as diabetes or cardiovascular disease) that may have contributed to the eye stroke. 

 

Are there other types of eye strokes? 

While central retinal artery occlusion (CRAO) is the most common type of eye stroke, there are others, including:

 

CRVO (Central Retinal Vein Occlusion)

CRVO, or Central Retinal Vein Occlusion, happens when the central vein of the retina becomes blocked or narrowed. This blockage prevents proper blood drainage from the retina, leading to fluid build-up and swelling.

 

The degree of loss of vision from CRVO depends on the extent of vein blockage and the size of the affected blood vessel. The most common risk factor for this condition is high blood pressure, diabetes, high cholesterol, and smoking.

 

BRVO (Branch Retinal Vein Occlusion) 

Branch Retinal Vein Occlusion is similar to CRVO; it involves the blockage of one of the smaller veins (or branches) draining blood from the retina, not the central vein.

 

BRAO (Branch Retinal Artery Occlusion)

BRAO, like BRVO, affects the smaller branches, but BRAO affects the arteries that bring fresh blood to the retina. A blockage in one of these branches can cause a sudden loss of vision in a part of your visual field.

 

CRVO, CRAO, BRVO, and BRAO are all considered medical emergencies that require immediate medical attention.

 

Why choose Assil Gaur Eye Institute for eye stroke treatment 

The AGEI staff includes a highly skilled retina specialist, Dr. Svetlana Pilyugina, or “Dr. P,” as she is known to her patients. Dr. Pilyugina is a Stanford-trained ophthalmologist with fellowship training and board certification in diseases and surgery of the vitreous and retina.

 

Dr. P has extensive experience treating macular degeneration, diabetic eye disease, retinal tears and detachment, flashes, floaters, and complex retinal conditions.

 

Apart from her eye care experience, Dr. P is known for her dedication to her patients and focus on personal service. That is why she limits the number of patients she sees daily in the clinic to allow her to dedicate sufficient time for evaluation and consultation with each patient to meet her high standard of care.

 

Assil Gaur Eye Institute team of ophthalmologists and optometrists are conveniently located for patients throughout Southern California and the Los Angeles area in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.

 

Sources: 

Central retinal vein occlusion (CRVO). (2022). 

https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/central-retinal-vein-occlusion-crvo

 

What Is Central Retinal Vein Occlusion (CRVO)? - American Academy of Ophthalmology https://www.aao.org/eye-health/diseases/what-is-central-retinal-vein-occlusion

 

Retinal Artery and Vein Occlusions Successfully Treated with Hyperbaric Oxygen - PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861035/

 

The Incidence of Central Retinal Artery Occlusion in Olmsted County, Minnesota - PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3326414/

 

Retinal manifestations in patients with SARS-CoV-2 infection and pathogenetic implications: a systematic review - PMC

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8356207

 

4 Ways COVID Leaves Its Mark on the Eye - American Academy of Ophthalmology https://www.aao.org/eye-health/tips-prevention/covid-damages-retina-eye-strokepinkeye

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