Objective:

To describe patient demographics, clinical characteristics, and treatment of patients diagnosed with acute retinal artery occlusion (RAO). 

Background:

RAO, a painless ocular ischemic stroke, causes sudden, often severe vision loss. With limited treatment options, the American Heart Association (AHA) recommends intravenous thrombolysis (IVT) within 4.5 hours or intra-arterial thrombolysis (IAT) within 6.5 hours of symptom onset.  

Design/Methods:

This retrospective study reviewed adult patients diagnosed with acute RAO from 2012 to September 2025 at a comprehensive stroke center. Patients with acute RAO were eligible for IVT within 4.5 hours or for IAT within 6.5 hours of symptom onset. Diagnosis was confirmed by ophthalmologic examination, and alternative causes were excluded. Summary data are reported. 

Results:

Fifty-three patients met inclusion criteria (35.8% branch RAO, 64.2% central RAO). Average age was 70.8+12.8 years;  64.2% were male. Hypertension was present in 80% and hyperlipidemia in 59%. Most (85%) presented outside the treatment window (range: 5 hours to three weeks), had unknown time of onset, or were on DOAC. Among eight treated, average time from symptom onset to diagnosis was 2.2+1.1 hours, and to treatment was 3.5+0.9 hours. Treatment included IV tPA (50.0%), IA tPA (25.0%), both IV tPA and IA tPA (12.5%), and IV TNK (12.5%). CTA showed significant ipsilateral carotid stenosis in 28.3%. Atrial fibrillation was present in 22.6%, with one new diagnosis. 

Conclusions:

This retrospective analysis of patients with acute retinal artery occlusion (RAO) reveals that the majority presented outside the therapeutic window, significantly limiting eligibility for intervention.  Along with a small subset who received treatment-via intravenous or intra-arterial thrombolysis-diagnosis and management were achieved promptly, with treatment initiated with an average of 3.5 hours from symptom onset.  These findings emphasized the critical need for heightened awareness, early recognition, and rapid triage to expand treatment opportunities and improve outcomes in acute RAO.