CRAO is an ophthalmic emergency analogous to an ischemic stroke of the retina and may herald underlying cerebrovascular disease. However, the magnitude and temporal profile of subsequent stroke risk remain insufficiently characterized in large, real-world cohorts.

After matching, 16,382 CRAO patients and 20,063 controls were included. Stroke incidence in the CRAO group was 5.2% versus 0.1% in controls at 30 days (risk ratio [RR], 40.1; risk difference [RD], 5.1%; 95% CI, 4.7–5.4), 7.1% versus 0.3% at 90 days (RR, 24.1; RD, 6.8%; 95% CI, 6.4–7.2), and 9.6% versus 0.9% at 1 year (RR, 10.7; RD, 8.7%; 95% CI, 8.3–9.1). At 3 years, stroke occurred in 11.3% versus 2.0% (RR, 5.8; RD, 9.4%; 95% CI, 9.0–9.8), at 5 years in 12.6% versus 2.8% (RR, 4.5; RD, 9.8%; 95% CI, 9.4–10.2), and at 10 years in 14.2% versus 3.6% (RR, 3.9; RD, 10.6%; 95% CI, 10.2–11.0). The relative risk declined progressively over time but remained significantly elevated throughout the decade of follow-up.

CRAO confers an extremely high risk of stroke within the first three months after onset, followed by a sustained long-term excess risk up to ten years. These findings identify CRAO as a sentinel cerebrovascular event requiring stroke evaluation and long-term preventive care.