Symptoms

Painless loss of vision

Clinical signs

Acute features

1. Diffuse retinal haemorrhages
2. Dilated tortuous retinal veins
3. Cotton-wool spots
4. Optic disc oedema
5. Macular oedema

Late features

1. Collateral venous channels
2. Hard exudates
3. Microaneurisms
4. Neovascularisation of the retina, optic disc
5. Neovascularization of the iris
6. Fibrous proliferation

Classification

1. Branch retinal vein occlusion -BRVO (haemorrhages in a sector of the retina along a retinal vein)
2. Central retinal vein occlusion –CRVO (diffuse retinal haemorrhages in all 4 quadrants of the retina)

Causes

1. Atherosclerosis
2. Hypertension
3. Glaucoma
4. Optic disc drusen
5. Hypercoagulable state
6. Vasculitis
7. Drugs (OCP, diuretics)
8. Retrobulbar external compression (tumor, thyroid eye disease)
9. Migraine

Management

1. Blood pressure
2. Blood test
3. Complete medical evaluation
4. Treat underlying medical disorders
5. Follow up 4-6 weeks for the first 6 months
6. Fluorescein angiography 6-12 weeks after acute symptoms
7. Laser treatment if neovascularisation or macular oedema