Objective: This study aims to investigate the clinical efficacy of intra-arterial thrombolysis (IAT) in the treatment of acute central retinal artery occlusion (CRAO) and to provide evidence for optimizing treatment strategies. Methods: A retrospective analysis was conducted on 29 CRAO patients treated between January 2024 and December 2024. Among them, 18 patients received intra-arterial thrombolysis, 6 patients received intravenous thrombolysis, and 5 patients received conventional treatment. Baseline characteristics, visual acuity recovery, and complication rates were compared among the three groups. SPSS 26.0 was used for statistical analysis. Results: The improvement in visual acuity at 24 hours in the intra-arterial thrombolysis group (ΔLogMAR=1.4) was significantly better than that in the intravenous tPA group (ΔLogMAR=1.2) and the conservative treatment group (ΔLogMAR=0.5). The most significant improvement in visual acuity at 30 days postoperatively was observed in the intra-arterial thrombolysis group (ΔLogMAR=1.2 ± 0.4), which was significantly better than that in the intravenous tPA group (ΔLogMAR=0.8 ± 0.3) and the conservative treatment group (ΔLogMAR=0.3 ± 0.2) (P<0.01). There was no significant difference in complication rates among the three groups (P>0.05). Conclusion: This study confirms that intra-arterial thrombolysis can effectively improve visual function and retinal blood perfusion in CRAO patients with good safety, providing a new evidence-based approach for clinical treatment. Future studies with larger sample sizes are needed to further validate its long-term efficacy.