Central retinal vein occlusion: Difference between revisions

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==Background==
==Background==
*Risk Factors
[[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]]
**[[Diabetes mellitus]]  
**Hypertension
**Hypercoagulable states
**Vasculitis
**Glaucoma


[[File:crvo.png|thumbnail|CRVO Blood and Thunder]]
===Risk Factors===
*[[Diabetes mellitus]]
*[[Hypertension]]
*Hypercoagulable states
*[[Vasculitis]]
*[[Glaucoma]]


==Clinical Features==
==Clinical Features==
*Loss of vision  
[[File:crvo.png|thumbnail|CRVO Blood and Thunder]]
*[[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==
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==Evaluation==
==Evaluation==
*[[Fundoscopy]]
**Optic disc edema, dilated and tortuous veins, diffuse retinal hemorrhages ("blood-and-thunder fundus")


==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

Latest revision as of 20:58, 16 December 2020

Background

Eye anatomy.

Risk Factors

Clinical Features

CRVO Blood and Thunder
  • 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)

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

  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.