Risk Management

Management of acute retinal ischemia

Update 1/9/20

Acute ophthalmic conditions present diagnostic and management challenges. To assist in assessing patients with acute presentations, including retinal ischemia, OMIC Committee member Dr. Gaurav Shah and retina fellow Dr. Alex Boutini of Retina Consultants, Ltd (St. Louis, MO) developed an algorithm called Acute Ophthalmic Presentations. We thank them for allowing us to share this decision tree.

February 2019

We would like to draw your attention to new guidelines on the management of acute retinal ischemia that indicate an urgent need to change how ophthalmologists approach patients with this condition. We also discuss what to do if your community does not have the recommended resources.

According to the guidelines published recently in Ophthalmology, “acute retinal arterial ischemia, including vascular transient monocular vision loss (TMVL) and branch (BRAO) and central retinal arterial occlusions (CRAO), are ocular and systemic emergencies requiring immediate diagnosis and treatment. Because the risk of stroke is maximum within the first few days after the onset of visual loss, prompt diagnosis and triage are mandatory. Eye care professionals must make a rapid and accurate diagnosis and recognize the need for timely expert intervention by immediately referring patients with acute retinal arterial ischemia to specialized stroke centers without attempting to perform any further testing themselves.”

If Your Community Does Not Have a Certified Stroke Center

The new guidelines suggest as an alternative immediately referring patients with TMVL, BRAO, or CRAO to observation units in Emergency Departments, or admitting them to hospitals.

  1. Determine what resources the nearest Emergency Department and hospitals have for evaluating patients with possible strokes.
  2. Explore the most efficient process for such patients. While a particular hospital might be closer, the patient may be better served by seeking care at a more distant facility with a predefined accelerated diagnostic protocol for such patients.
  3. Formulating a plan now on how to implement these guidelines will promote patient safety and reduce your liability exposure.


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