Retinal vein occlusion is the second most common retinal vascular disorder and a cause of painless vision loss.
It is divided into branch retinal vein occlusion (most common) and central retinal vein occlusion. Each of these subdivisions are further divided into ischaemic (worse prognosis, poorer vision) and non-ischaemic. It is worth noting non-ischaemic CRVO can transform into ischaemic in 30% of cases
Presentation
BRVO – painless decrease in vision or visual field defect
CRVO – usually sudden, painless unilateral visual loss
Investigation
- Fundoscopy
- Retinal haemorrhages (blot and flame shaped)
- Increased tortuosity of retinal veins
- Cotton wool spots
- Papilloedema
- Macular oedema
- Relative afferent papillary defect
- ? Fluorescein angiography
Risk factors for RVO
- Age
- Hypertension
- Diabetes
- Smoking
- Hyperlipideamia
- Open angle glaucoma
- Myeloproliferative disorders – 1% of those with RVO
- Systemic vasculitis e.g. Behcet’s disease, PAN
Management
- Refer to ophthalmology:
- Investigation and treatment of risk factors
- Laser photocoagulation
- Anti-VEGF agents (bevacizumab, ranbizumab, pegaptanib)
- Dexamethasone intravitreal implant
Complications
- Glaucoma
- Iris neovascularisation
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