PGI Ralph Nico L.

Masa
Post Graduate Intern 2019-2020
Central Retinal Vein Occlusion

What is Central Retinal Vein Occlusion?

Arteries and veins carry blood throughout your body, including your eyes. The
eye’s retina has one main artery and one main vein. When the main retinal vein becomes
blocked, it is called central retinal vein occlusion (CRVO).
When the vein is blocked, blood and fluid spills out into the retina. The macula can swell
from this fluid, affecting your central vision. Eventually, without blood circulation, nerve
cells in the eye can die and you can lose more vision.

What are symptoms of CRVO?

The most common symptom of CRVO is vision loss or blurry vision in part or all of one
eye. It can happen suddenly or become worse over several hours or days. Sometimes,
you can lose all vision suddenly.
You may notice floaters. These are dark spots, lines or squiggles in your vision. These
are shadows from tiny clumps of blood leaking into the vitreous from retinal vessels.
In some more severe cases of CRVO, you may feel pain and pressure in the affected
eye.

Who is at risk for CRVO?

CRVO usually happens in people who are aged 50 and older.
People who have the following health problems have a greater risk of CRVO:

 high blood pressure

 diabetes
 glaucoma
 hardening of the arteries (called arteriosclerosis)

To lower your risk for CRVO, you should do the following:

 eat a low-fat diet

 get regular exercise
 maintain an ideal weight
 don’t smoke

Types of Central Retinal Vein Occlusion

My studies showed that CRVO is actually of two types, with very different prognoses and
management. The two types are:

 Non-ischemic type or venous stasis retinopathy.

 Ischemic type or hemorrhagic retinopathy.

Classification of CRVO into non-ischemic and ischemic CRVO is essential because non-
ischemic CRVO is a comparatively benign disease, with permanent central scotoma as the
major complication from cystoid macular edema (see below). This type of CRVO does not
develop the most dreaded complication of ocular neovascularization. In contrast to that,
ischemic CRVO is a seriously blinding disease, and anterior segment neovascularization
leading to neovascular glaucoma is its major complication

Signs of CRVO
 Fundoscopic findings in CRVO. Flame-shaped hemorrhages all over, Swelling of the disc and
Macular edema

Fluorescein Angiography

CAUSES OF VISUAL LOSS

Venous Stasis
 Hemorrhage
 Macular edema
Ischemic
 Poorer vision
 Macular ischemia as diagnosed by fluorescein angiography (usually, wait for 3 months
until the blood in the macula disappears)
Complications of CRVO
 Residual hemorrhage
 Neovascularization
 Hemorrhagic glaucoma
 5 to 20% of patients
 Usually within 90 days
 Rubeosisiridis
 Red eye(painful), high IOP, glaucoma
MANAGEMENT
 Intravitreal steroids and or anti-VGEF for macular edema
 Laser photocoagulation of leaking vessels
 Anticoagulants for incipient occlusion
 Rule out: Open angle glaucoma