Background <p>Microvascular changes in the retina can be detected in children with thromboembolism. These changes in the retina can be measured with optical coherence tomography angiography (OCTA).</p> Aim <p>This study aims to evaluate retinal microvascular changes in pediatric patients who have experienced central nervous system thromboembolic events using OCTA.</p> Methods <p>This cross-sectional study included 36 children aged 7–16&#xa0;years. Comprehensive ophthalmic evaluations, including OCTA imaging using the AngioVue system, were performed. Retinal vascular density (VD), retinal thickness, and foveal avascular zone (FAZ) parameters were evaluated in predefined macular regions. Radial peripapillary capillary vessel density (RPCVD) and retinal nerve fiber layer (RNFL) thickness were also measured.</p> Results <p>Compared to the control group, patients with thromboembolism exhibited a significant reduction in vascular density across all sectors of the deep capillary plexus&#xa0;(<i>p</i> &lt; 0.05). Additionally, a significant decrease in vascular density was noted in the nasal sector of the superficial capillary plexus (<i>p</i> &lt; 0.05). No significant difference was observed in the FAZ area between the groups (<i>p</i> &gt; 0.05). RNFL thickness was significantly lower in all sectors in the patient group (<i>p</i> &lt; 0.05). In contrast, peripapillary RPCVD was significantly higher in the patient group compared to the control group (<i>p</i> &lt; 0.05).</p> Conclusion <p>OCTA enables the noninvasive detection of retinal microvascular alterations in pediatric patients with thromboembolism. These findings highlight the early vascular involvement associated with the disease and may serve as a valuable tool for clinical monitoring and follow-up.</p>