How is a physical exam performed in central retinal artery occlusion (CRAO)?

Updated: Jun 11, 2019
  • Author: Robert H Graham, MD; Chief Editor: Andrew G Lee, MD  more...
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Determine the degree of vision loss (eg, no light perception, hand movement, counting fingers).

Ocular examination includes the following:

  • Check for a relative afferent pupillary defect (rAPD).
  • Perform an optic nerve examination to look for signs of temporal arteritis (eg, concomitant ischemic optic neuropathy or cilioretinal artery occlusion). Critical signs include the rAPD and pale/swollen optic nerve (pallid edema) with splinter hemorrhages.
  • Cherry-red spot and a ground-glass retina may take hours to develop.
  • The funduscopic findings typically resolve within days to weeks of the acute event, sometimes leaving a pale optic disc as the only physical finding.
  • Emboli can be seen in about 20% of patients with CRAO.
  • Boxcar segmentation can be seen in both arteries and veins. This is a sign of severe obstruction.

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