Skip to Main Content

For further information, see CMDT Part 7-17: Central & Branch Retinal Vein Occlusions

KEY FEATURES

Essentials of Diagnosis

  • Sudden monocular loss of vision

  • No pain or redness

  • Widespread or sectoral retinal hemorrhages

General Considerations

  • Common causes of acute vision loss

  • Branch retinal vein occlusion is four times more common than central retinal vein occlusion

  • The major predisposing factors are the etiologic factors in arteriosclerosis (diabetes mellitus, systemic hypertension, hyperlipidemia) and glaucoma

  • Consider estrogen therapy (including oral contraceptives), inherited or acquired hypercoagulable states (thrombophilia) (see below), and antiphospholipid antibody syndromes

  • In bilateral retinal vein occlusions, consider hyperviscosity syndromes and paraproteinemias

CLINICAL FINDINGS

Symptoms and Signs

  • Central vein occlusion

    • Ophthalmoscopic signs include

      • Widespread retinal hemorrhages

      • Retinal venous dilation and tortuosity

      • Retinal cotton-wool spots

      • Optic disk swelling

    • Rarely, presents with severe vision loss and pain

      • Occurs when neovascularization of the iris develops

      • Usually about 90 days after a central retinal vein occlusion has caused severe retinal nonperfusion

  • Branch retinal vein occlusions 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 (neovascularization)

    • More gradual visual loss may occur with development of macular edema

    • In acute cases, the retinal abnormalities (hemorrhages, microaneurysms, venous dilation and tortuosity, and cotton-wool spots) are confined to the area drained by the obstructed vein

DIAGNOSIS

  • Check blood pressure

  • Ask about tobacco use

  • Ask women about estrogen therapy (including oral contraceptives)

  • Patients should also be asked about a history of glaucoma; intraocular pressure should be measured to assess for signs of open- or narrow-angle glaucoma

Laboratory Tests

  • Obtain screening studies for diabetes mellitus, hyperlipidemia, and hyperviscosity (especially in simultaneous bilateral disease), including serum protein electrophoresis

  • In younger patients, consider tests for

    • Antiphospholipid antibody syndrome (lupus anticoagulant)

    • Activated protein C resistance/Factor V Leiden

    • Protein C, protein S deficiency

    • Antithrombin deficiency

    • Hyperprothrombinemia (G20210A prothrombin gene mutation)

    • Increased factor VIII activity

    • Hyperhomocysteinemia

TREATMENT

Therapeutic Procedures

Macular Edema

  • Intravitreal injection of a vascular endothelial growth factor (VEGF) inhibitor (such as ranibizumab, bevacizumab, or aflibercept) is beneficial for macular edema due to either branch or central retinal vein occlusion

  • Intravitreal triamcinolone improves vision in chronic macular edema due to non-ischemic central retinal vein occlusion

  • Intravitreal implant containing dexamethasone

    • Beneficial in both central and branch retinal vein occlusion

    • However, carries the risk of glaucoma in 20–65% of patients

    • Causes cataract in all patients who have not already had cataract surgery

    • Retinal laser photocoagulation

      • May be indicated in chronic macular edema due to branch, but not central, retinal vein occlusion

      • Most ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

  • Create a Free Profile