RETINAL VEIN OCCLUSION

Question 1

What are the two types of retinal vein occlusion and what are their differences?

Answer 1

Central retinal vein occlusion (CRVO)

Branch retinal vein occlusion (BRVO)

Causes are similar but treatment is different

Question 2

What are the main causes of retinal vein occlusion (both types)?

Answer 2

Hypertension

Arteriosclerosis

Diabetes

Hypercoagulable states - SLE, antiphospholipid syndrome

Oral contraception

Question 3

What are the causes of central retinal vein occlusion exclusively (ie don’t commonly cause branch retinal vein occlusion)?

Answer 3

Primary open angle glaucoma

Inflammatory eye disease: Sarcoidosis and Syphilis

Polycythaemia

Lymphoma

Myeloma

Question 4

What are the causes of branch retinal vein occlusion exclusively (ie don’t commonly cause central retinal vein occlusion)?

Answer 4

Inflammatory eye disease with vasculitis: Behcet’s

Question 5

What are the clinical features of retinal vein occlusion?

Answer 5

Sudden painless loss of vision

Unilateral

Relative afferent pupil defect

Flame haemorrhages - in central vein occlusion bleeding will be in all four quadrants

Cotton wool spots

Disc swelling

Macular oedema

Neovascularization

Question 6

What are the investigations that should be done for anyone who presents with retinal vein occlusion?

Answer 6

BP

Bloods: FBC, lipids, BM, ESR, TFT,

Coagulation screen

Protein C and S

Autoantibody screen

ECG

Fluorescein angiogram

Question 7

What are the two types of central retinal vein occlusion?

Answer 7

Ischaemic

Non-ischaemic

Question 8

In terms of clinical features what are the differences between ischaemic and non-ischaemic central retinal vein occlusion?

Answer 8

Ischaemic - greater degree of visual loss (to less than 6/60)
Also involves relative afferent pupil defect

Non-ischaemic - better than 6/60 vision
No relative afferent pupil defect

Question 9

What are the complications of untreated ischaemic central retinal vein occlusion?

Answer 9

75% develop neovascularization

50% neovascular glaucoma (rubreosis)

Question 10

How do we treat someone with central retinal vein occlusion?

Answer 10

Laser treatment for neovascularization

Clinical trials ongoing for medical treatment

Frequent follow up - every 2-4 weeks

Question 11

How do we treat someone with branch retinal vein occlusion?

Answer 11

Usually none required. Treat causes.

Laser used if neovascularization.

Follow up 4 months