Central retinal vein occlusion

Background

  • Risk Factors
CRVO Blood and Thunder

Clinical Features

  • Loss of vision
    • Variable, ranging from vague blurring to rapid, painless monocular vision loss

Differential Diagnosis

Acute Vision Loss (Noninflamed)

Emergent Diagnosis

Evaluation

  • Fundoscopy
    • Optic disc edema, dilated and tortuous veins, diffuse retinal hemorrhages ("blood-and-thunder fundus")

Management

  • Consult ophtho and neuro
  • No treatment regimen provides significant and consistent results
  • Complex treatment possibly involving aspirin, anticoagulation, fibrinolysis, lowering IOP, topical steroids, cyclocryotherapy, photocoagulation, intravitreal injections (triamcinolone, anti-VEGF, aflibercept) while managing underlying medical diseases
  • Possible benefit from LMWH plus aspirin in central retinal vein occlusion[1]
    • May provide a 78% risk reduction of adverse ocular outcome in central vein occlusion
    • Less benefit in branched retinal vein occlusion

Disposition

See Also

Acute Vision Loss (Noninflamed)

References

  1. Lazo-Langner A et al. Low molecular weight heparin for the treatment of retinal vein occlusion: a systematic review and meta-analysis of randomized trials. Haematologica. 2010 Sep; 95(9): 1587–1593.

Authors:

Ross Donaldson