Central retinal artery occlusion (CRAO) is a critical eye condition similar to a stroke in the brain, causing sudden vision loss with poor prognosis. It is associated with increased risk of ischaemic heart disease and stroke due to underlying atherosclerotic risk factors. Currently, there is no officially recommended treatment for CRAO. This review discusses the anatomy, pathophysiology, clinical features, and management of CRAO. CRAO is relatively rare, with an incidence of 1.9 per 100,000 person-years in the US. It is more common in older adults, and the incidence is increasing globally. CRAO can be classified into transient non-arteritic, arteritic, and non-arteritic types. The most common cause is thromboembolism, with embolic sources identified in about 55% of cases. Arteritic CRAO is associated with inflammatory conditions like giant cell arteritis. Clinical features include sudden, painless vision loss, with visual acuity often worse than counting fingers. Patients often present late, with a mean delay of 31.2 hours to review by a medical practitioner. Risk factors include advanced age, male gender, cardiovascular disease, and smoking. CRAO is associated with a high risk of future cardiovascular and cerebrovascular events. Management of CRAO is divided into acute, subacute, and chronic phases. Acute treatment options include thrombolysis with tPA or tenecteplase, which may improve visual acuity but has limited evidence of long-term effectiveness. Intra-arterial thrombolysis is another option but requires specialized expertise and has higher complication rates. Other acute treatments, such as paracentesis and hyperbaric oxygen therapy, have shown variable results. Subacute management focuses on preventing secondary complications like ocular neovascularization. Secondary prevention involves controlling atherosclerotic risk factors through multidisciplinary care, including neurology, ophthalmology, and primary care. Antiplatelet therapy is recommended for patients without contraindications. Future research aims to confirm the efficacy of thrombolysis in CRAO and develop standardized treatment protocols. CRAO is an urgent ophthalmic emergency, and timely intervention is crucial for visual recovery. Current guidelines emphasize the importance of prompt diagnosis and treatment to improve outcomes.Central retinal artery occlusion (CRAO) is a critical eye condition similar to a stroke in the brain, causing sudden vision loss with poor prognosis. It is associated with increased risk of ischaemic heart disease and stroke due to underlying atherosclerotic risk factors. Currently, there is no officially recommended treatment for CRAO. This review discusses the anatomy, pathophysiology, clinical features, and management of CRAO. CRAO is relatively rare, with an incidence of 1.9 per 100,000 person-years in the US. It is more common in older adults, and the incidence is increasing globally. CRAO can be classified into transient non-arteritic, arteritic, and non-arteritic types. The most common cause is thromboembolism, with embolic sources identified in about 55% of cases. Arteritic CRAO is associated with inflammatory conditions like giant cell arteritis. Clinical features include sudden, painless vision loss, with visual acuity often worse than counting fingers. Patients often present late, with a mean delay of 31.2 hours to review by a medical practitioner. Risk factors include advanced age, male gender, cardiovascular disease, and smoking. CRAO is associated with a high risk of future cardiovascular and cerebrovascular events. Management of CRAO is divided into acute, subacute, and chronic phases. Acute treatment options include thrombolysis with tPA or tenecteplase, which may improve visual acuity but has limited evidence of long-term effectiveness. Intra-arterial thrombolysis is another option but requires specialized expertise and has higher complication rates. Other acute treatments, such as paracentesis and hyperbaric oxygen therapy, have shown variable results. Subacute management focuses on preventing secondary complications like ocular neovascularization. Secondary prevention involves controlling atherosclerotic risk factors through multidisciplinary care, including neurology, ophthalmology, and primary care. Antiplatelet therapy is recommended for patients without contraindications. Future research aims to confirm the efficacy of thrombolysis in CRAO and develop standardized treatment protocols. CRAO is an urgent ophthalmic emergency, and timely intervention is crucial for visual recovery. Current guidelines emphasize the importance of prompt diagnosis and treatment to improve outcomes.