We treated 14 consecutive patients for acute central retinal artery occlusion. Eleven were treated with urokinase introduced through a microcatheter in the proximal segment of the ophthalmic artery. Fibrinolysis was succeeded by heparinization for two to three days. Instead of urokinase, we used tissue plasminogen activator in three patients. Vision improved markedly in four of the 14 patients. Five others had slight improvement of visual acuity, visual field, or both. In five patients, no change occurred. Such a recovery of visual acuity may be anticipated if treatment begins within the first few hours after the onset of central retinal artery occlusion. A control group of 41 consecutive patients treated conservatively showed almost no improvement in visual acuity. Eleven of these 41 patients were treated within the first six hours after the patient noticed the onset of blindness.