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PubMed This is a summary of 20 peer-reviewed journal articles Updated
Ophthalmology

Arteritic vs. Non-Arteritic: Finding the Cause of Your Eye Stroke

At a Glance

Central retinal artery occlusion (CRAO) has two main types. Arteritic CRAO is an inflammatory emergency caused by Giant Cell Arteritis requiring immediate steroids to save your other eye. Non-arteritic CRAO is caused by blood clots, signaling an urgent need for cardiovascular care.

One of the most important tasks your medical team has is determining why the blockage in your eye occurred. While the result—a loss of vision—is the same, the cause of a Central Retinal Artery Occlusion (CRAO) generally falls into one of two very different categories: Arteritic (A-CRAO) and Non-Arteritic (NA-CRAO) [1][2].

Distinguishing between these two is critical because the treatment for one is meant to stop a systemic inflammatory attack, while the treatment for the other focuses on heart and vessel health [3][4].

Arteritic CRAO (A-CRAO): The Inflammatory Emergency

Arteritic CRAO is almost always caused by Giant Cell Arteritis (GCA), a condition where the lining of your arteries becomes inflamed and swollen, eventually closing off blood flow [3][1]. This is a “whole-body” disease that happens to manifest in the eye.

Why It Is a Direct Threat to the Other Eye

GCA is a medical emergency because the inflammation is systemic. If left untreated, there is a high risk that the inflammation will spread and cause a similar “stroke” in your other eye, potentially leading to total blindness [3][5][6].

To prevent this, doctors must start high-dose corticosteroids (steroids) immediately—even before they have finished all the diagnostic tests or a biopsy—to calm the inflammation and protect the “good” eye [3][7].

Warning Signs of GCA

If you are over age 50 and have a CRAO, your doctor will look for these systemic “red flags”:

  • Scalp Tenderness: Pain when brushing your hair or wearing glasses [8].
  • Jaw Claudication: Pain or cramping in the jaw or tongue specifically when chewing [8].
  • Temporal Headache: A new, persistent pain on the side of your head [9].
  • High Inflammatory Markers: Blood tests (ESR and CRP) that show high levels of inflammation in the body [3][8].

Non-Arteritic CRAO (NA-CRAO): The Vascular Event

Non-Arteritic CRAO is the most common form and is usually caused by a physical blockage, like a blood clot or a piece of cholesterol (an embolus) that has broken loose from elsewhere in the body [1][10].

This type of CRAO is a signal that your cardiovascular system needs urgent attention. It is strongly linked to:

  • Carotid Artery Disease: Narrowing or plaque in the large arteries in your neck [11][12].
  • Atrial Fibrillation (Afib): An irregular heart rhythm that can cause blood to pool and clot in the heart [13][14].
  • Hypertension: Long-term high blood pressure that damages vessel walls [15].

Subtype Comparison Matrix

Feature Arteritic (A-CRAO) Non-Arteritic (NA-CRAO)
Primary Cause Giant Cell Arteritis (Inflammation) [1] Clots or cholesterol plaques [16]
Urgent Treatment High-dose Corticosteroids [3] Clot-dissolving meds or O2 therapy [4]
Main Risk Blindness in the other eye [5] Future brain stroke or heart attack [16]
Key Symptoms Jaw pain, scalp tenderness, headache [8] Usually no pain; sudden vision loss only [17]
Key Tests ESR, CRP, Temporal Artery Biopsy [3] Carotid ultrasound, Echocardiogram [18]

Regardless of the subtype, a CRAO is a “warning shot” from your body. Whether the cause is inflammation or a clot, the goal of your care team is to stabilize your condition and prevent further vascular events [19][20].

Common questions in this guide

What is the difference between arteritic and non-arteritic CRAO?
Arteritic CRAO is caused by severe inflammation of the blood vessels, usually from a condition called Giant Cell Arteritis. Non-arteritic CRAO is caused by a physical blockage like a blood clot or cholesterol plaque traveling from another part of the body.
Why is giant cell arteritis (GCA) a medical emergency?
Giant Cell Arteritis causes systemic inflammation that can quickly spread to your other eye if left untreated. Doctors must start high-dose steroids immediately to prevent total blindness, even before diagnostic tests are finished.
What are the warning signs of arteritic CRAO?
Warning signs of arteritic CRAO include scalp tenderness when brushing your hair, a cramping pain in your jaw when chewing, and a new, persistent headache on the side of your head. These symptoms indicate dangerous systemic inflammation.
What causes a non-arteritic eye stroke?
A non-arteritic eye stroke usually occurs when a blood clot or piece of cholesterol travels from the heart or neck arteries and blocks the retinal artery. It is strongly linked to underlying cardiovascular issues like atrial fibrillation, high blood pressure, and carotid artery disease.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my symptoms and blood tests, is my condition classified as Arteritic or Non-Arteritic?
  2. 2.If you suspect Giant Cell Arteritis (GCA), when should I start high-dose corticosteroids, and for how long?
  3. 3.Does my imaging show signs of both CRAO and optic nerve damage (AION), and why is that combination a 'red flag'?
  4. 4.Will I need a temporal artery biopsy to confirm the diagnosis of GCA?
  5. 5.What specific heart or neck imaging do I need to find the source of the clot if this is Non-Arteritic?

Questions For You

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References

References (20)
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    Casella AMB, Mansour AM, Ec S, et al.

    International journal of retina and vitreous 2022; (8(1)):69 doi:10.1186/s40942-022-00422-z.

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    Central Retinal Artery Occlusion With Subsequent Central Retinal Vein Occlusion in Biopsy-Proven Giant Cell Arteritis.

    Williams ZR, Wang X, DiLoreto DA

    Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society 2016; (36(3)):290-1 doi:10.1097/WNO.0000000000000385.

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    Giant Cell Arteritis With Bilateral Central Retinal Artery Occlusion and Tongue Necrosis.

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    Diagnostic accuracy of the history, physical examination, and laboratory testing for giant cell arteritis.

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This page explains the causes and subtypes of central retinal artery occlusion for educational purposes. Always seek immediate emergency medical care for sudden vision loss.

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