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Central retinal artery occlusion (CRAO) represents a critical ophthalmological emergency characterized by sudden, painless monocular vision loss and requires immediate intervention within emergency department settings. This narrative review examines the current evidence regarding CRAO management, emphasizing its pathophysiology, risk factors, clinical presentation, diagnostic approaches, and therapeutic interventions. The condition's complex etiology encompasses both embolic and inflammatory processes, with significant associations to cardiovascular risk factors and systemic diseases. Despite its critical nature, CRAO management faces substantial challenges, including delayed patient presentation, limited therapeutic windows, and the absence of universally accepted treatment protocols. Current diagnostic approaches incorporate traditional fundoscopic examination alongside emerging technologies such as point-of-care ultrasound and optical coherence tomography. While conventional management strategies include ocular massage, intraocular pressure reduction, and systemic therapies, their efficacy remains limited by insufficient evidence from randomized controlled trials. Emerging therapeutic approaches, including targeted thrombolysis, hyperbaric oxygen therapy, and novel surgical interventions, show promise but require further investigation. The review emphasizes the importance of a multidisciplinary approach involving emergency medicine, ophthalmology, and neurology specialists to optimize patient outcomes. Future directions highlight the potential of artificial intelligence-assisted diagnostics, standardized "eye stroke" protocols, and ongoing research into novel therapeutic interventions. Success in addressing these challenges requires continued investigation through rigorous clinical trials, improved public awareness regarding CRAO symptoms, and enhanced emergency department protocols to facilitate rapid diagnosis and treatment initiation.