What should I do if I lose sight of my eyes momentarily? What kind of disease could it be? Today, I met a young patient in the emergency room who had been unable to see out of his right eye for 5 hours and had no light perception in his right eye on examination. The patient was very anxious: “Please hurry, save my eye!” Unbeknownst to the patient, such a situation is the best time for the patient to miss the best treatment. The diagnosis was “central retinal artery occlusion (RAO)”, after which the patient was resuscitated according to the emergency procedure. What exactly is this disease? Retinal artery occlusion is a common clinical emergency in ophthalmology, with rapid onset, severe visual impairment and poor prognosis. Because of its rapid onset, so timely resuscitation is the key to restore vision, and to a large extent save the patient’s vision, perhaps restore part of the useful vision, otherwise the visual function is lost forever. 1.What is retinal artery occlusion? Monocular, painless, rapid loss of vision, and may have a history of transient blackness before onset. A few patients have the aura of one-eye transient blackness, which may return to normal after a few minutes. This symptom may recur many times, resulting in the final vision cannot be restored, and most patients have a sudden and drastic loss of vision to manual or only light sense in front of the eyes within a few seconds, and in severe cases, the vision drops to no light sense. 2.Classification of retinal artery obstruction RAO is usually classified according to different obstruction sites: central retinal artery obstruction, branch retinal artery obstruction, ciliary retinal artery obstruction. RAO can also be classified into complete blockage and incomplete blockage according to the degree of blockage. 3.How to save yourself in case of RAO? You should massage the eye with your finger immediately, repeat the massage for at least 10 minutes, massage with pressure for 10 seconds, release the finger for 5 seconds, and so on for about 10 times, so as to lower the intraocular pressure and increase the perfusion of retinal vessels, and at the same time, relax and don’t be too nervous, then look for the nearest ophthalmic emergency room for treatment. Timely and clear diagnosis and reasonable and timely treatment is the key to the success of vision salvage. 4.The effect of RAO on vision? If the central retinal artery is blocked for more than 2 hours, even if the blood supply is restored, the vision will be severely damaged and difficult to recover, and it is generally believed that the possibility of recovery of vision beyond 6 hours is extremely small. 5.Ocular manifestation The pupil shows RAPD (+), and the fundus shows retinal artery thinning and retinal gray-white edema in the posterior pole. The central macular sulcus shows cherry red spot. 6.What are the examination methods of RAO? (1) OCT of macula: the photoreceptor layer is obviously widened, the reflexivity is weakened, the neuroepithelial layer is enhanced, and the tissue structure of each layer cannot be distinguished. (2) Fundus fluorescence angiography (FFA): shows no or insufficient perfusion of central/branch arteries. 7. Who can develop RAO? RAO can occur in people of any age because it is mainly due to the blockage of retinal arteries by emboli, which is equivalent to “myocardial infarction” in terms of damage. Common emboli include: cholesterol emboli, platelet fibrin emboli, calcified emboli, tumor emboli, fat emboli, septic emboli, drug emboli, etc. Valve emboli, commonly seen in subacute endocarditis, atherosclerotic plaques. Tissue emboli: shed tumor cells. Sometimes the onset is associated with endogenous toxins (such as influenza, malaria), exogenous toxins (such as quinine or lead poisoning), retrobulbar anesthesia, drugs injected into the face and jaw, and prone general anesthesia surgery, which puts prolonged pressure on the eye. 8.Is it related to hypertension, arteriosclerosis, hyperlipidemia, etc.? How to prevent it? In the pathological mechanism, it is mainly the change of blood vessel wall: atherosclerosis or atherosclerosis, or inflammation, which makes the endothelial cells of blood vessels damaged, proliferate, the inner wall becomes rough, the lumen becomes narrow, and it is easy to form blood clots. In the elderly mostly have cardiovascular disease, or with vascular sclerosis, high blood lipids, high blood viscosity, high blood sugar, etc. prone to RVO. 9, one eye has occurred, the other eye will occur, what are the signs before the onset? The disease usually develops in one eye, rarely both eyes at the same time, before the onset of the disease often had one or more times of transient black, after rest or a few minutes to relieve themselves, this may be a transient spasm of the retinal arterial vessels, it must be paid great attention to, should go to the hospital blood sedimentation, C-reactive protein and platelets to exclude giant cell arteritis, measurement of blood pressure, fasting blood sugar, glycated hemoglobin, complete blood cell count plus classification, prothrombin time/activated partial thromboplastin kinase time (PT/PTT’). Patients younger than 50 years of age, or with causative factors or positive systemic signs, were checked for lipid profile, antinuclear antibodies (ANA), rheumatoid factor (RF), spirochetal antibody adsorption fluorometry (FTA-ABS), serum protein electrophoresis, hemoglobin electrophoresis, and antiphospholipid antibodies. Ultrasound examination of carotid artery, DSA examination if necessary. 10.Rescuing process When the disease occurs, the vasospasm must be released as soon as possible, or the embolus must be pushed into the distal smaller branches to reduce the scope of retinal involvement, so as to salvage some of the vision as early as possible. Each specialized center has a specific process plan.