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Central retinal artery occlusion results from vascular spasm, thrombosis, or external compression, obstructing blood supply to the inner retina, causing acute ischemia and severe vision loss. This condition is one of the ophthalmologic emergencies leading to blindness. Our department treated 21 cases of central retinal artery occlusion from March 1995 to March 2001 using integrated TCM and Western medicine, achieving satisfactory results, reported below.1. Clinical DataThe cohort included 21 cases: 18 males, 3 females; age ranged from 28 to 66 years, average 54 years; right eye affected in 14 cases, left eye in 7 cases. Occupations: 3 car drivers, 10 civil servants, 8 retirees. Duration of illness ranged from 20 minutes to 24 hours. Examination findings: visual acuity less than finger counting at close range. Pupils varied in dilation, direct light reflex weakened or absent, indirect light reflex present. Fundus vessels appeared linear or completely devoid of blood flow. Posterior pole retina showed gray-white, cloudy edema, with cherry-red spot at macula.2. Treatment MethodsUpon confirmed diagnosis, immediately administer sublingual nitroglycerin 10mg, inject torasol 1205mg retrobulbarly, or inject compound camphor oil into the temporal superficial artery and orbital area, each 2ml. Apply local eyeball massage. Oral acetazolamide 500mg, combined with oxygen therapy. Concurrently, administer compound Danshen 16ml intravenously once daily, 10 sessions constitute one course. Additionally, orally take compound Danshen tablets and Vitanol for blood-activating and stasis-resolving effects.3. Efficacy Observation3.1 Efficacy Criteria:Marked improvement: visual acuity ≥1.0;Effective: visual acuity improved by ≥3 lines;Improvement: visual acuity improved by 1–2 lines;Ineffective: no change in visual acuity.3.2 Treatment ResultsAfter one course of treatment, follow-up for 3 months: 5 cases marked improvement, 11 effective, 4 improved, 1 ineffective, total effective rate 95.2%. Restoration order of fundus vessels: nasal superior, temporal superior, then nasal inferior, temporal inferior.4. DiscussionThe central retinal artery and its branches are terminal arteries supplying blood to the inner retina. The retina is highly sensitive to circulatory disturbances. In animal (rabbit) experiments, complete blockage of the central artery leads to retinal necrosis within 30 minutes. Another report indicates the retina tolerates temporary ischemia for about 100 minutes. Therefore, this condition is an ophthalmologic emergency requiring immediate rescue to restore circulation before retinal necrosis occurs, thereby achieving good outcomes. In our cohort, 5 cases showed marked improvement. Possible reasons for successful rescue: younger patients whose occlusion may result from fatigue and transient hypertension causing vascular spasm; timely use of vasodilators and drugs relieving microvascular spasm allowed gradual restoration of circulation. Second, patients presented early, and we actively secured treatment time. Third, we initiated blood-activating and stasis-resolving TCM early in treatment. Research confirms that blood-activating and stasis-resolving herbs have four major effects in treating ocular ischemic diseases: ① vasodilation, reducing vascular resistance; ② improving microcirculation, enhancing hypoxia tolerance; ③ inhibiting fibrin synthesis, anticoagulation, and tissue hyperplasia; ④ inhibiting release of allergic mediators, anti-allergic reactions. These actions accelerated recanalization of blocked arteries. Some unsatisfactory outcomes may relate to older age, higher degree of vascular sclerosis, and delayed presentation.Although numerous clinical reports on central retinal artery occlusion exist, detailed observations are rare. Through observation, we found the sequence of retinal vessel reperfusion is nasal superior → temporal superior → nasal inferior → temporal inferior, i.e., from distal to proximal gradually returning to normal. Although blood supply to the superior and inferior temporal branches is restored, the macula still shows mild edema, possibly because the blood supply to the macula’s periphery comes from the superior and inferior retinal arterial branches, which form radial vascular loops that have not fully recovered.Literature reports 21 cases of central retinal artery occlusion, with 2 occurring in the morning. In our cohort, 5 cases occurred around 6 a.m., possibly due to the transition from slow blood flow during sleep to rapid flow upon waking, causing a sharp increase in chemicals like adrenaline, leading to faster blood flow, vasoconstriction, increased blood pressure, and higher blood viscosity approaching peak levels during the day—thus predisposing to vascular spasm, especially in those with hypertension or arteriosclerosis. Therefore, gently moving limbs before getting out of bed can gradually accelerate blood flow, helping prevent vascular events.Central retinal artery occlusion is not just a local ocular condition but also a symptom of systemic disease. Therefore, while treating this condition, it is essential to actively manage the underlying systemic diseases causing it.