Central or branch retinal vein occlusion

Retinal vein occlusion is a common vascular disorder caused by impaired venous blood flow. 
It is second only to diabetes mellitus as a vascular cause of impaired vision.

Presentation:

  • Sudden onset painless blurred vision
  • Less commonly the patient may present with painful red eye due to neovascular glaucoma
  • as a result of recent central retinal vein occlusion.
Examination
  • The visual acuity is reduced in central retinal vein occlusion. However, the reduction is 
  • dependent on the severity of the occlusion. In branch retinal vein occlusion, the visual 

    • acuity may be normal if the fovea is not involved. 
  • Relative afferent pupillary defect may be present in patient with severe central retinal vein 

    • occlusion
  • Ophthalmoscopy reveals extensive intraretinal and pre-retinal haemorrhage with distended 

    • retinal veins.
Management:
  • Refer within 24 hours.
  • Although there is no immediate treatment that can restore the vision, it is important to 

    • examine the patient for hypertension and glaucoma. A blood test is usually performed for 
    full blood count, ESR and in young patients auto-immune screening.
  • Follow-up in the clinic is arranged so that those at risk of neovascular glaucoma may be 

    • treated with laser pan-photocoagulation
Figure 1
A classical picture of central retinal vein occlusion showing extensive 
flamed haemorrhages. 
Figure 2
This hypertensive patient complains of a sudden onset drop in his left vision. 
Fundal examination reveals a left superior temporal branch retinal vein 
occlusion. There are multiple flammed haemorrhages and cotton wool
spots along  the occluded vein.

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