Branch Retinal Arterial Occlusion

In early March 2007, I experienced a BRAO – at the time I thought the problem would go away,  after 48 hours I was admitted to hospital / ophthalmology as an emergency.

BRAO and Pigmentary Glaucoma were diagnosed in the right eye. The BRAO has resulted in a small amount of central vision loss – I am taking Timolol for the Glaucoma to manage ocular pressure. My vision is still good (with assistance for myopia) and there has been no change in the BRAO.

I had many blood tests, Electro Cardiogram, Echo Cardiogram, Doppler (carotid arteries) and chest xray – all of which showed no underlying disease/condition. There are a few hereditary indicators (history of stroke and heart attack) plus high cholesterol. My cholesterol is 4.8 (HDL, 1.8, LDL, 2.8, Trig 0.54). I am a 35 yr old male and in good health. Cardiologist indicated high LDL as most probable cause and has prescribed Atorvastatin + low dose aspirin.

I would like to ensure I have explored every possibility here. The family history does not indicate any major arterial or thrombotic disease. I have been told this is a very rare occurrence in someone of my age.

Should I consider neurological investigation/MRI?
Are there any possible/rare causes that may have been missed through the tests?
I’ve been told the Glaucoma and BRAO are not related – I am not sure, can increased pressure be a factor in both glaucoma and arterial occlusion?

[John C Hagan III, MD, FACS, FAAO]

Hello Warwick,  You fail to mention whether you are male or female. If female are you on birth control pills? Is your blood pressure okay? Do you smoke? Are you seriously overweight?
Lab Studies:


Laboratory studies are helpful in determining the etiology of CRAO but do not affect ED treatment.
Obtain a CBC to evaluate anemia, polycythemia, and platelet disorders.
Evaluate the erythrocyte sedimentation rate (ESR) for inflammatory endarteritis in the absence of another etiology.
Measure fibrinogen level, antiphospholipid antibodies, prothrombin time (PT), activated partial thromboplastin time (aPTT), and serum protein to evaluate for coagulopathies.
Obtain a fasting blood sugar level, cholesterol, triglycerides, and lipid panel to evaluate for atherosclerotic disease.
Evaluate blood cultures for bacterial endocarditis and septic emboli.
Imaging Studies:


Imaging studies are helpful in determining the etiology of CRAO but do not affect ED treatment.
Echocardiogram is not necessarily an ED test, but it can be used to evaluate valvular disease, wall motion abnormalities, mural thrombi, and vegetations that may cause septic emboli.
Carotid Doppler ultrasound can be used to evaluate atherosclerotic disease, although a magnetic resonance angiogram may be more accurate in detecting obstruction.
Other Tests:


Perform an ECG to evaluate for possible atrial fibrillation (24-hour Holter monitor may be necessary if arrhythmia is suspected but not detected on ECG testing).


JCH III MD     Eye MD
The association of branch retinal artery occlusion (BRAO) is less well established due to glaucoma than branch retinal vein occlusion which is well established.

I do not think that a MRI would add any useful information.

This is from e-medicine and outlines the blood work that is usually indicated to be checked: