Central retinal vein occlusion

Background

• Risk Factors
  • DM
  • HTN
  • Hypercoagulable states
  • Vasculitis
  • Glaucoma

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)

• 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
• 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
  • May provide a 78% risk reduction of adverse ocular outcome in central vein occlusion
  • Less benefit in branched retinal vein occlusion

See Also

Acute Vision Loss (Noninflamed)