Intraocular hemorrhage in patients misdiagnosed with central retinal artery occlusion treated with thrombolysis

Daniel V Adamkiewicz¹Kevin Y Yan¹Christian Leal¹Sruthi R Arepalli¹Kevin Ferenchak¹Blaine Cribbs¹Riley J Lyons¹Étienne Bénard-Séguin²Nancy Newman¹Valerie Biousse^1*

• ¹School of Medicine, Emory University, Atlanta, United States
• ²University of Calgary, Calgary, Alberta, Canada

The diagnosis of acute central retinal artery occlusion (CRAO) is commonly delayed in emergency departments (ED) where ophthalmologists are rarely available for immediate consultation. Thrombolysis is sometimes given empirically for presumed CRAO without confirmation of the diagnosis with ocular funduscopic examination. We describe 1 case of severe intraocular hemorrhage following intravenous thrombolysis for a retinal detachment misdiagnosed as a CRAO, and 2 cases of worsening intraocular hemorrhage following intravenous thrombolysis for misdiagnosed CRAO, and review the literature. We aim to demonstrate the importance of confirming a diagnosis of CRAO prior to the administration of intravenous thrombolytics, as ocular hemorrhage is a rare but potentially devastating complication of thrombolysis in patients with underlying retinal disorders other than CRAO. Thus, thrombolysis should never be given for acute vision loss without a funduscopic examination or ocular imaging confirming the diagnosis of CRAO.