Central Retinal Artery Occulsion - differential diagnosis of its cause

Hi,
I've been diagnosed with CRAO 3 years ago, having inspected by several ophtalmologists since.
The actual cause of the occulsion is not clear, and I've recently started investigating the matter on my own. I would appreciate if you could answer this question for me:
Is it possible to determine whether the condition is the result of an acute chronic occlusion (i.e. an embolism), or if it is the result of a temporary hypoperfusion?
Are the symptoms different for each case? If so, how?

Thank you very much for your help.

[Michael J Kutryb, MD]

Your question is quite a thoughtful and reminds me of one that I would ask.  In the end the only way to prove an embolic occlusion would be to see the embolus or other emboli.  If the patient had terribly diseases carotid arteries or heart valves with small emboli found in the eye or other areas then that would of course suggest an embolic cause.  Probably difficult to prove, as I said.

Regarding hypoperfusion, it would be more likely to occur at night while sleeping as the blood pressure drops or possible after major surgery, especially heart surgery.  Again, difficult to prove.  
Sometimes I think there is just generalized severe atherosclerosis especially of the small and medium sized vessels combined possibly with some carotid artery disease so it can just be very difficult to tell the cause.  If the vessels appear to be rather healthy, with no smoking and normal cholesterol you may also need to look into the possibility of a vasculitis of some sort of a clotting disorder of the blood.  Talk to your ophthalmologist and see what he thinks the cause was.

Michael Kutryb, MD
Kutryb Eye Institute
Titusville, FL
Edgewater, FL