Secondary Stroke Prevention and Management for the Neuro-Ophthalmologist

J Neuroophthalmol. 2020 Dec;40(4):463-471. doi: 10.1097/WNO.0000000000001133.


Background: This article will serve as a comprehensive review of secondary prevention of ischemic stroke and central and branch retinal artery ischemia, which are closely linked pathologically and can be managed similarly to prevent further reoccurrence.

Evidence acquisition: We conducted a search in PubMed with a focus on reports involving secondary stroke prevention.

Results: This review discusses the etiologies of stroke and addresses the evidence for optimal therapies for secondary stroke prevention. We review recent clinical trials that will serve as an aid to the neuro-ophthalmologist in practice to determine the best next step in management and when to consider further referral to a stroke specialist.

Conclusions: The optimal treatment to prevent stroke recurrence is determined by the etiology of stroke. After stroke workup, patients will typically be placed on proper medical therapy for the appropriate duration in addition to counseling on lifestyle modifications to reduce the risk of recurrent strokes. For complex patients, it is reasonable for providers to consider patient referral to stroke specialists for further aid in selection of appropriate medical therapy.

Publication types

  • Review

MeSH terms

  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Neurology*
  • Ophthalmologists
  • Ophthalmology*
  • Risk Factors
  • Secondary Prevention / methods*
  • Stroke / prevention & control*


  • Fibrinolytic Agents