Central retinal artery occlusion (CRAO) is an ocular emergency and is the ocular 
analogue of cerebral stroke. It results in profound, usually monocular vision 
loss, and is associated with significant functional morbidity. The risk factors 
for CRAO are the same atherosclerotic risk factors as for stroke and heart 
disease. As such, individuals with CRAO may be at risk of ischemic end organ 
damage such as a cerebral stroke. Therefore, the management of CRAO is not only 
to restore vision, but at the same time to manage risk factors that may lead to 
other vascular conditions. There are a number of therapies that has been used in 
the treatment of CRAO in the past. These include carbogen inhalation, 
acetazolamide infusion, ocular massage and paracentesis, as well as various 
vasodilators such as intravenous glyceryl trinitrate. None of these "standard 
agents" have been shown to alter the natural history of disease definitively. 
There has been recent interest shown in the use of thrombolytic therapy, 
delivered either intravenously or intra-arterially by direct catheterisation of 
the ophthalmic artery. Whilst a number of observational series have shown that 
the recovery of vision can be quite dramatic, two recent randomised controlled 
trials have not demonstrated efficacy. On the contrary, intra-arterial delivery 
of thrombolytic may result in an increased risk of intracranial and systemic 
haemorrhage, while the intravenous use of tissue plasminogen activator (tPA) was 
not shown to be efficacious within 24 h of symptom onset. Nevertheless, both of 
these studies have shown one thing in common, and that is for treatment to be 
effective in CRAO, it must be deployed within a short time window, probably 
within 6 h of symptom onset. Therefore, while CRAO is a disease that does not 
have a treatment, nevertheless it needs to follow the same principles of 
treatment as any other vascular end organ ischaemic disease. That is, to attempt 
to reperfuse ischemic tissue as quickly as possible and to institute secondary 
prevention early.