Central retinal artery occlusion (CRAO) causes ischemic stroke of the eye. We 
report a case of CRAO that was successfully treated with intravenous recombinant 
tissue plasminogen activator (rt-PA) and review the current literature. A 
64-year-old right-handed man presented to the emergency department with acute 
left eye amaurosis. An ophthalmologic assessment revealed a left afferent 
pupillary defect, minimal visual acuity, macular edema with a cherry red spot, 
and multiple emboli in the inferotemporal arcade of the left eye. A neurologic 
examination was otherwise nonfocal; neuroimaging was normal. Acute CRAO was 
diagnosed, and rt-PA was administered intravenously 185 minutes after symptom 
onset. A repeat examination 4.5 hours after treatment found improved vision, 
reduced macular edema, and no emboli. An ophthalmologic evaluation 10 days later 
found a visual acuity of 20/200 in the left eye and bilateral arterial sclerosis 
without evidence of retinal emboli or macular edema. This case illustrates that 
intravenous rt-PA may be an effective therapeutic option for CRAO in select 
patients. Given the current literature and the recommended established safety 
window for thrombolytics in acute ischemic cerebral stroke, it is reasonable to 
administer intravenous treatment for CRAO within 4.5 hours after symptom onset. 
Nevertheless, it is critical that a prospective clinical trial confirm the 
efficacy, safety, and time window for treatment.