Central retinal vein occlusion: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
| Line 2: | Line 2: | ||
*Risk Factors | *Risk Factors | ||
**[[Diabetes mellitus]] | **[[Diabetes mellitus]] | ||
**Hypertension | **[[Hypertension]] | ||
**Hypercoagulable states | **Hypercoagulable states | ||
**Vasculitis | **[[Vasculitis]] | ||
**Glaucoma | **[[Glaucoma]] | ||
[[File:crvo.png|thumbnail|CRVO Blood and Thunder]] | [[File:crvo.png|thumbnail|CRVO Blood and Thunder]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Loss of vision | *[[vision loss|Loss of vision]] | ||
**Variable, ranging from vague blurring to rapid, painless monocular vision loss | **Variable, ranging from vague blurring to rapid, painless monocular vision loss | ||
*[[Fundoscopy]] | |||
**Optic disc edema, dilated and tortuous veins, diffuse retinal hemorrhages ("blood-and-thunder fundus") | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 17: | Line 19: | ||
==Evaluation== | ==Evaluation== | ||
==Management== | ==Management== | ||
*Consult ophtho and neuro | *Consult ophtho and neuro | ||
*No treatment regimen provides significant and consistent results | *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 | *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 provide a 78% risk reduction of adverse ocular outcome in central vein occlusion | **May provide a 78% risk reduction of adverse ocular outcome in central vein occlusion | ||
**Less benefit in branched retinal vein occlusion | **Less benefit in branched retinal vein occlusion | ||
Revision as of 16:15, 5 October 2019
Background
- Risk Factors
- Diabetes mellitus
- Hypertension
- Hypercoagulable states
- Vasculitis
- Glaucoma
Clinical Features
- Loss of vision
- Variable, ranging from vague blurring to rapid, painless monocular vision loss
- Fundoscopy
- Optic disc edema, dilated and tortuous veins, diffuse retinal hemorrhages ("blood-and-thunder fundus")
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
Evaluation
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
- ↑ 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.