Emergency Department Presentation of Retinal Artery Occlusion

Published:November 03, 2021DOI:



      To determine how often patients who present to the Emergency Department (ED) for retinal artery occlusions (RAOs) undergo brain imaging, cardiovascular testing, and are hospitalized.


      Retrospective cross-sectional study.


      Patients who presented to the ED with a RAO in the National Emergency Department Sample (NEDS), a nationally representative US database.


      The NEDS was queried from 2006–2014 to identify patients who presented to the ED with the primary diagnosis of RAO. Patient and hospital characteristics were evaluated, and a multivariable regression was performed to determine predictors of hospitalization. Testing was categorized into three groups: 1) brain imaging – computed tomography and/or magnetic resonance; 2) carotid imaging – ultrasound, computed tomography, and/or magnetic resonance; 3) cardiac testing – electrocardiogram and/or echocardiogram. The number of tests performed for each category was recorded.

      Main Outcome Measures

      Proportions of patients undergoing brain imaging, carotid imaging, and/or cardiac testing. Rate and predictors for hospitalization.


      Among 259,343,582 ED visits, 2, 802 had a primary diagnosis of RAO. Patients were mostly ≥ 65 years old (59%) and male (54%). Hypertension (59%), dyslipidemia (36%), and diabetes (20%) were the most common pre–existing cardiovascular diseases. Brain imaging, carotid imaging, and cardiac testing were performed in 20.3%, 7.1%, and 23.8% of patients, respectively; at least one test from each of these three categories was performed in 4.1% of patients. Half of the patients were hospitalized. Factors that increased the chances of hospitalization included (P < 0.05): age < 45 years old; female sex; being a smoker; presenting to a metropolitan hospital; having giant cell arteritis, carotid artery disease, atrial fibrillation, cardiac valve disease, obesity, dyslipidemia, hypertension, diabetes, and chronic ischemic heart disease.


      Most patients who presented to the ED with a RAO did not receive emergent brain imaging, carotid imaging, or basic cardiac testing. A multidisciplinary approach is needed to raise awareness that RAOs should be treated as a precursor of stroke or a stroke equivalent.


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