Synopsis
Identify acute retinal arterial ischaemia, activate emergency ophthalmic and stroke assessment, recognise arteritis and interpret reperfusion evidence without delaying care.
- Central occlusion threatens much of the inner retina; a branch occlusion causes a territorial defect and can leave central acuity deceptively good.
- An early retina may lack the full classic appearance, so a missing cherry-red spot does not exclude acute arterial ischaemia.
- Evaluate for embolic sources and systemic vascular disease while ophthalmology confirms the ocular diagnosis.
Key red flags
Sudden persistent monocular loss, a marked RAPD or new focal visual-field loss requires immediate assessment for retinal arterial occlusion and associated vascular disease.
Investigation priorities
Define the deficit and establish the timeline needed for emergency decisions.
Management branches
A sudden monocular or territorial visual deficit is ongoing or acute retinal arterial occlusion is suspected.
- Arrange immediate emergency assessment and provide onset, last-known-well time, acuity, pupil findings and the possibility of arteritis.
- Ensure ophthalmology and the stroke team coordinate diagnostic confirmation, vascular investigation and any time-sensitive specialist decision.
Key medicines
Glucocorticoids for visually threatening suspected GCAA specialist may give methylprednisolone 500 mg to 1 g intravenously daily for a maximum of three consecutive days before oral prednisolone. If intravenous treatment is unavailable immediately, do not delay oral treatment: BSR permits prednisolone 60–100 mg by mouth daily for up to three days as the initial bridge, followed by the agreed ongoing regimen and taper.
Aspirin when the episode is a resolved suspected TIAGive aspirin 300 mg orally once daily immediately, unless contraindicated, while arranging specialist assessment within twenty-four hours of symptom onset. Continue until the acute team establishes the diagnosis and specifies the definitive antithrombotic regimen; this is not a prescription for automatic indefinite high-dose aspirin.