MRCP PACES Eyes Central Retinal Vein Occlusion

History

  • Sudden onset
  • Painless loss of vision or blurred vision
CVRO. Credit: Werner JU, Böhm F, Lang GE, Dreyhaupt J, Lang GK, Enders C, CC BY 4.0, via Wikimedia Commons

Physical examination

  • Relative afferent pupillary defect
  • Fundoscopy
    • Scattered, diffuse retinal haemorrhage
    • “Blood and thunder” fundus
    • Dilated, tortuous veins
    • Optic disc oedema
    • Cotton wool spots – retinal ischaemia
    • Arterioles may be attenuated

Risk factors

  • Age
  • Hypertension
  • Diabetes
  • Smoking
  • Obesity
  • Glaucoma – affects retinal vein outflow
  • Hypercoagulable states
    • Antiphospholipid syndrome
    • Nephrotic syndrome
    • Factor V Leiden
    • Protein C deficiency
    • Protein S deficiency
    • Hyperhomocysteinaemia
    • Underlying malignancy

Complications

  • Ocular neovascularization
    • Vitreous haemorrhage
    • Traction retinal detachment
    • Neovascular glaucoma

Management

  • Multidisciplinary team approach
  • Refer to ophthalmology
  • Control cardiovascular risk factors
  • Consider intra-viteal anti-vascular endothelial growth factor (VEGF) for neovascularization with macular oedema
  • Laser phototherapy for neovascularization
  • Consider intravitreal glucocorticoids (second-line)
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