Carotid artery disease and central retinal artery occlusion

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Central retinal artery occlusion (CRAO) is a devastating ocular event with a dismal visual prognosis.1 The visual crisis caused by CRAO may be the first manifestation of an underlying disease process such as atherosclerosis of the carotid artery. A number of studies based on clinical, nonangio-graphic methods have estimated the incidence of ipsilateral carotid artery disease to be 8% to 25% of those affected with CRAO.2–4 In contrast, one roentgenographic study demonstrated that nine of nine patients with CRAO had angiographically demonstrable ipsilateral carotid artery disease.5

Because of the great disparity between the coincidence of carotid artery disease and CRAO in clinical and angiographic studies, we reviewed our cases of CRAO with special attention to the incidence of angiographically abnormal carotid arteries. Our results confirm a high association between carotid artery disease and CRAO. Three cases of CRAO with normal carotid angiograms are reported to emphasize that the association between these two events is significant, and clearly less than 100%.


Thirty cases of CRAO occurring in 27 patients were seen at The Cleveland Clinic Foundation between 1969 and 1978. The age range of the patients, 17 men (63%) and 10 women (37%) was from 21 to 75 years (mean, 57 years).

Men were most often affected in their 60s and women in their 70s (Table 1). The right eye was affected in 14 patients (52%), the left in ten patients (37%), and three patients had bilateral CRAOs (11%).


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