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ESSENTIALS OF DIAGNOSIS

ESSENTIALS OF DIAGNOSIS

  • Sudden monocular loss of vision.

  • No pain or redness.

  • Widespread or sectoral retinal hemorrhages.

GENERAL CONSIDERATIONS

Central and branch retinal vein occlusion are common causes of acute vision loss, with branch vein occlusions being four times more common. The major predisposing factors are the etiologic factors associated with arteriosclerosis, but glaucoma is also a major risk factor.

CLINICAL FINDINGS

A. Symptoms and Signs

Ophthalmoscopic signs of central retinal vein occlusion include widespread retinal hemorrhages, retinal venous dilation and tortuosity, retinal cotton-wool spots, and optic disk swelling (Figure 7–2)(eFigure 7–47) (eFigure 7–48). Rarely, central retinal vein occlusion presents with severe vision loss and pain when neovascularization of the iris develops, usually about 90 days after a central retinal vein occlusion has caused severe retinal nonperfusion.

Figure 7–2.

Acute central retinal artery occlusion with cherry-red spot (arrow) seen at the fovea centered in macular loss of retinal transparency, and preserved retinal perfusion (arrowheads) adjacent to the optic disk due to macular cilioretinal artery supply. (Reproduced, with permission, from Riordan-Eva P, Augsburger JJ. Vaughan & Asbury’s General Ophthalmology, 19th ed. McGraw Hill, 2018.)

eFigure 7–47.

Central retinal vein occlusion.

eFigure 7–48.

Ultra-widefield (Optomap) image of central retinal vein occlusion with retinal hemorrhages throughout the retina and a cotton-wool spot (arrow). (Used, with permission, from S Kiss and Optos plc.)

Branch retinal vein occlusion may present in a variety of ways. Sudden loss of vision may occur at the time of occlusion if the fovea is involved, or some time afterward from vitreous hemorrhage due to retinal new vessels. More gradual visual loss may occur with development of macular edema. In acute branch retinal vein occlusion, the retinal abnormalities (hemorrhages, microaneurysms, venous dilation and tortuosity, and cotton-wool spots) are confined to the area drained by the obstructed vein (eFigure 7–49) (eFigure 7–50).

eFigure 7–49.

Branch retinal vein occlusion with intraretinal hemorrhages and cotton wool spots limited to the distribution of the inferotemporal branch retinal vein.

eFigure 7–50.

Fluorescein angiogram of superior temporal branch retinal vein occlusion of left eye showing macular microvascular changes (arrow). (Used, with permission, from S Kiss and Optos plc.)

To assess for possible reversible risk factors, check blood pressure and ask about tobacco smoking in all patients, and ask women about estrogen therapy (including combined oral contraceptives). Patients should also be asked ...

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