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Fundus Photography and Fluorescein Angiography of Branch Retinal Artery Occlusion

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Title: Fundus Photography and Fluorescein Angiography of Branch Retinal Artery Occlusion
Author: Johnny Lippincott
Photographer: Unknown
Date: 8/28/2017

Keywords/Main Subjects: Branch Retinal Artery Occlusion, BRAO, Retinal Vascular Disease
CORE Category:
Disorders of the Retina and Vitreous: Other Retinal Vascular Diseases, 8: Arterial Occlusive Disease


Diagnosis: Branch Retinal Artery Occlusion
Description of Image: Branch Retinal Artery Occlusion (BRAO) is the obstruction of adequate bloodflow to a retinal artery distal to the central retinal artery. Hypoperfusion of downstream tissue leads to retinal ischemia, cell damage, and vision loss. More than two-thirds of BRAOs are caused by emboli composed of either cholesterol, platelet-fibrin, or calcific plaques.1 Cholesterol emboli are known as Hollenhurst plaques. Emboli tend to occlude vessels at points of bifurcation. BRAOs are almost always found in the temporal, not nasal, arteries.2

Patients typically present with monocular sudden, painless vision loss in a sectoral or altitudinal distribution. Severity of vision loss (in field and acuity) varies significantly and depends on the area affected and degree of ischemia. 80% of affected eyes recover visual acuity of 20/40 or better.3 Given this rate of recovery, invasive therapy is usually avoided in cases without significant foveal involvement. Ocular massage or paracentesis can dislodge an embolus (albeit rarely), and employing laser therapy to disrupt an embolus may improve visual outcomes but is associated with vitreous hemorrhages.2, 4

This fundus photograph demonstrates characteristic findings in BRAO, including a sectoral area of opaque (“cloudy”), whitened, edematous retina. Retinal veins form the boundaries of this ischemic area, which here includes part of the superior fovea. A cotton-wool spot has developed (arrow). Though not seen in this photograph, an embolus is visible on fundus photography in a majority of cases. Fluoroscein angiography displays a hyperfluorescent spot (arrow) that may represent the culprit embolus that has migrated beyond the point of occlusion. The area of ischemia is hypofluorescent.


  1. Hayreh SS, Zimmerman MB. Fundus changes in branch retinal arteriolar occlusion. Retina. 2015 Oct 1;35(10):2060-6.
  2. Yanoff M, Duker JS. Retinal arterial obstruction. Ophthalmology 4th edition. Elsevier Saunders. 2014;129.
  3. Brown GC, Magargal LE, Shields JA, Goldberg RE, Walsh PN. Retinal arterial obstruction in children and young adults. Ophthalmology. 1981 Jan 1;88(1):18-25.
  4. Man V, Hecht I, Talitman M, Hilely A, Midlij M, Burgansky-Eliash Z, Achiron A. Treatment of retinal artery occlusion using transluminal Nd: YAG laser: a systematic review and meta-analysis. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2017:1-9.

Faculty Approval by: Griffin Jardine, MD

Copyright statement: Copyright Johnny Lippincott, ©2016. For further information regarding the rights to this collection, please visit:

Disclosure (Financial or other): The author has no financial or business interests that may be affected by this site or its contents.

Identifier: Moran_CORE_24567