Central Retinal Artery Occlusion: A Treatable Ocular Emergency

Abstract

Central retinal artery occlusion (CRAO) is an ophthalmic emergency presenting with sudden, painless vision loss and is associated with poor visual prognosis. No universally effective treatment has been established. We report a case of a 47-year-old male who presented within 2 h of symptom onset with features suggestive of early CRAO and a visible embolus at the level of the central retinal artery. Ocular massage was performed under slit-lamp visualization, resulting in initial dislodgement of the embolus. Subsequent anterior chamber paracentesis led to distal migration of the embolus into a branch arteriole. This was associated with significant improvement in visual acuity from counting fingers close to the face to 6/24 within 24 h and 6/9 at 20-day follow-up. This case highlights the potential role of early intervention in facilitating embolus migration and partial restoration of retinal perfusion. Real-time visualization of embolus migration following these interventions is rarely documented and may explain favorable visual outcomes in selected cases.