Central retinal vein occlusion: Difference between revisions
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==Management== | ==Management== | ||
*Consult ophtho and neuro | *Consult ophtho and neuro | ||
*Complex treatment involving aspirin, lowering IOP, topical steroids, cyclocryotherapy, photocoagulation, intravitreal injections (triamcinolone, anti-VEGF, aflibercept) while managing underlying medical diseases | *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<ref>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.</ref> | *Possible benefit from LMWH plus aspirin in central retinal vein occlusion<ref>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.</ref> | ||
**May be ~80% risk reduction of adverse ocular outcome in central | **May be ~80% risk reduction of adverse ocular outcome in central | ||
**Less benefit in branched retinal vein occlusion | **Less benefit in branched retinal vein occlusion | ||
**Not much we can do as EPs other than ASA and anticoagulation, but should be done under concert with ophtho c/s | |||
== See Also == | == See Also == | ||
Revision as of 07:47, 2 February 2016
Background
Risk Factors
- DM
- HTN
- Hypercoagulable states
- Vasculitis
- Glaucoma
Clinical Features
- Loss of vision
- Variable, ranging from vague blurring to rapid, painless monocular vision loss
Differential Diagnosis
Acute Vision Loss (Noninflamed)
- Painful
- Arteritic anterior ischemic optic neuropathy
- Optic neuritis
- Temporal arteritis†
- Painless
- Amaurosis fugax
- Central retinal artery occlusion (CRAO)†
- Central retinal vein occlusion (CRVO)†
- High altitude retinopathy
- Open-angle glaucoma
- Posterior reversible encephalopathy syndrome (PRES)
- Retinal detachment†
- Stroke†
- Vitreous hemorrhage
- Traumatic optic neuropathy (although may have pain from the trauma)
†Emergent Diagnosis
Diagnosis
- Fundoscopy
- Optic disc edema, dilated and tortuous veins, diffuse retinal hemorrhages ("blood-and-thunder fundus")
Management
- Consult ophtho and neuro
- 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 be ~80% risk reduction of adverse ocular outcome in central
- Less benefit in branched retinal vein occlusion
- Not much we can do as EPs other than ASA and anticoagulation, but should be done under concert with ophtho c/s
See Also
Acute Vision Loss (Noninflamed)
References
- ↑ 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.