Central retinal artery occlusion (CRAO) is an ophthalmic emergency and the 
ocular analogue of cerebral stroke. Best evidence reflects that over 
three-quarters of patients suffer profound acute visual loss with a visual 
acuity of 20/400 or worse. This results in a reduced functional capacity and 
quality of life. There is also an increased risk of subsequent cerebral stroke 
and ischaemic heart disease. There are no current guideline-endorsed therapies, 
although the use of tissue plasminogen activator (tPA) has been investigated in 
two randomized controlled trials. This review will describe the pathophysiology, 
epidemiology, and clinical features of CRAO, and discuss current and future 
treatments, including the use of tPA in further clinical trials.