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Symptoms ⬇

Unilateral, painless, abrupt change in vision, usually partial visual field loss; may have a history of transient visual loss (amaurosis fugax).

Signs ⬆ ⬇

(See Figure 11.7.1.)

Critical

Superficial opacification or whitening along the distribution of a branch retinal artery. The affected retina becomes edematous.

Other

Narrowed branch retinal artery; boxcarring, segmentation of the blood column, or emboli are sometimes seen in the affected branch retinal artery. Cholesterol emboli appear as bright, reflective crystals, usually at a vessel bifurcation. CWSs may appear in the involved area.

11-7.1 Branch retinal artery occlusion with Hollenhorst plaque.

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Etiology ⬆ ⬇

See 11.6, CENTRAL RETINAL ARTERY OCCLUSION.

Work Up ⬆ ⬇

Workup

See 11.6, CENTRAL RETINAL ARTERY OCCLUSION. Unlike in CRAO, an ERG is not helpful.

NOTE:

When a BRAO is accompanied by optic nerve edema or retinitis, obtain appropriate serologic testing to rule out cat-scratch disease (Bartonella [Rochalimaea] henselae), syphilis, Lyme disease, and toxoplasmosis.

Treatment ⬆ ⬇

  1. The AAO 2018 guidelines suggest that all these patients should be sent immediately to an emergency department, preferably affiliated with a stroke center, for evaluation and workup. See treatment in 11.6, CENTRAL RETINAL ARTERY OCCLUSION.
  2. No ocular therapy of proven value is available.
  3. Treat any underlying medical problem.

Follow Up ⬆

  1. Patients need immediate evaluation to treat any underlying disorders (especially GCA).
  2. Reevaluate every 3 to 6 months initially to monitor progression. Ocular neovascularization after BRAO is rare.