Central retinal artery occlusion (CRAO) is a medical emergency that, if not 
treated, may result in irreversible loss of vision. It continues to be an 
important cause for acute painless loss of vision. Amaurosis fugax or "transient 
CRAO" has long been considered an equivalent of transient cerebral ischemic 
event. Animal models, in addition to data from retrospective and randomized 
clinical studies, provide valuable insights into the time interval for 
irreversible retinal ischemia. Subset analyses from 2 large studies of patients 
with CRAO show benefit from treatment with thrombolysis within 6 hours from 
symptoms onset. Significant workflow improvements after the intra-arterial 
therapy trials for acute ischemic stroke have occurred world over in last 5 
years. Patients with CRAO are uniquely suited to receive maximum benefits from 
the changes in workflow for treatment of patient's acute ischemic stroke. Just 
as in clinical triage of acute ischemic stroke, correct and timely diagnosis of 
patients with CRAO may help in preventing visual loss. The approach to acute 
ocular ischemia should mimic that used for acute brain ischemia. Comprehensive 
stroke centers would be ideal triage centers for these patients in view of 
availability of multidisciplinary participation from vascular neurology, 
neuroendovascular surgery, and ophthalmology. Time is Retina!