Retinal Vein Occlusion

Retinal vein occlusion refers to the closure of the central retinal vein that drains the retina or to that of one of its branches.

Description

Retinal vein occlusion (RVO) occurs when the central retinal vein, the blood vessel that drains the retina, or one of its branches becomes blocked. RVO may be categorized by the anatomy of the occluded vein and the degree of ischemia produced. The two major RVO types are central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). CRVO has been diagnosed in patients as young as nine months to patients of 90 years. The age of affected individuals is usually low to mid 60s. Approximately 90% of patients are over 50 at the time of diagnosis, with 57% of them being male and 43% being female. BRVO accounts for some 30% of all vein occlusions.

Causes and symptoms

CRVO is a painless loss of vision that can be caused by a swollen optic disk, the small area in the retina where the optic nerve enters the eye, by dilated retinal veins, and by retinal hemorrhages. CRVO is also called venous stasis retinopathy, or hemorrhagic retinopathy.

In BRVO, the superotemporal branch vein is the most often affected vessel. Retinal hemorrhages follows, often occurring at the crossing of two vessels near the optic disk. Initially the hemorrhage may be extensive and underlie the fovea.

The exact cause of RVO is not yet identified, but the following mechanisms been proposed:

• external compression between the central connective strand and the cribriform plate
• venous disease
• blood clot formation

Conditions associated with RVO risk include:

• hypertension
• hyperlipidemia
• diabetes mellitus
• hyperviscosity
• hypercoagulability
• glaucoma
• trauma

Diagnosis

A complete physical evaluation is recommended for CRVO and BRVO, including complete blood tests, and glucose tolerance test (for non-diabetics). In the case of a head injury when bleeding around the optic nerve is a possibility, an MRI may be performed.

Treatment

Following a patient with RVO is vital. Patients should be seen at least monthly for the first three months to monitor for signs of other complications, such as the abnormal formation of blood vessels (neovascularization) in the iris of the eye or glaucoma.

The treatment for retinal vein occlusion varies for each case and should be given based on the doctor's best recommendation. Although treatments for occlusion itself are limited, surgical treatment of the occlusion provides an option.

Treatments may include anticoagulants with heparin, bishydroxycoumarin, and streptokinase. When the blood is highly viscous, dilution of the blood may be useful. Ideally, an alternate pathway is needed to allow venous drainage. Recent reports published in 1999 suggest that use of a laser to create a retinal choroidal hole may be useful to treat CRVO. Laser therapy depends on the type of occlusion. The management of laser therapy should be controlled by an ophthalmologist.

Alternative treatment

There are no documented alternative treatment methods.

Prognosis

The outlook for people with RVO is fairly good whether it is treated early or not. With no treatment at all, approximately 60% of all patients recover 20/40 vision or better within a year.

Prevention

Retinal vein occlusion is difficult to prevent because the exact cause is still uncertain. Ethnic factors may play a role since in the UK the disease is rare in Asians and West Indians.