Retinal artery occlusion (RAO) remains one of the most vision-threatening conditions in ophthalmology. Most patients experience a dramatic, unilateral and painless loss of vision, which can lead to blindness. No causal therapy has yet been established, which is why there is currently no obligation to treat. Intravenous fibrinolysis therapy is currently being investigated in clinical trials and is the most promising option to date, but its benefits have not yet been proven. This therapy is established for ischaemic stroke but is based on the very narrow 4.5-hour time window which is comparable to stroke therapy. This time window has not yet been definitively established for RAV, but clinically every minute counts. Emergency admission to a neurological clinic is recommended, as there is an increased risk of further embolic and ischaemic events. Even though underlying giant cell arteritis (GCA) is rare, GCA must always be considered as a possible cause.