Summary
Definition
History and exam
Key diagnostic factors
- sudden, painless vision loss
- optic nerve head edema
- intraretinal hemorrhage
- venous tortuosity and dilation
- collateral vessel formation
Other diagnostic factors
- age >65 years
- neovascularization
- vitreous hemorrhage
- macular edema
- floaters
- painful, red eye
- visual acuity
- relative afferent pupillary defect
- elevated intraocular pressure
Risk factors
- atherosclerosis
- systemic hypertension
- diabetes mellitus
- hyperlipidemia
- history of smoking
- cardiovascular disease
- glaucoma
- increased body mass index at 20 years of age
- increased serum alpha-2 globulin
- short axial length
- age >65 years
- activated protein C resistance
- factor V Leiden
- hypercoagulable state
- protein S deficiency
- antithrombin III deficiency
- hyperhomocysteinemia
- vasculitis
Diagnostic tests
1st tests to order
- fluorescein angiogram for confirmation of diagnosis
Tests to consider
- fluorescein angiogram for assessment of complications
- optical coherence tomography
- electroretinography
Treatment algorithm
CRVO: uncomplicated
CRVO with macular edema
CRVO with neovascularization
BRVO or HRVO: uncomplicated
BRVO or HRVO with macular edema
BRVO or HRVO with neovascularization
Contributors
Authors
Aziz A. Khanifar, MD
![Aziz A. Khanifar](/api/image/959/en-us/normal/959-auth-1_default.jpg)
Vitreoretinal Surgeon
The Retina Group of Washington
Silver Spring
MD
Disclosures
AAK has been reimbursed by Genentech, Regeneron and Iveric Bio.
Acknowledgements
Dr Aziz A. Khanifar would like to gratefully acknowledge Dr Sharon Fekrat, a previous contributor to this topic.
Disclosures
SF declares that she has no competing interests.
Peer reviewers
Stephen G. Schwartz, MD
Assistant Professor of Clinical Ophthalmology
Bascom Palmer Eye Institute
University of Miami Miller School of Medicine
Naples
FL
Disclosures
SGS has received research funding from Alcon, Genentech, and Novartis; holds equity in Pfizer; and is co-holder of a patent pending entitled "Molecular targets for modulating intraocular pressure and differentiation of steroid responders from non-responders".
Tim Murray, MD
Professor of Ophthalmology
Bascom Palmer Eye Institute
University of Miami Miller School of Medicine
Naples
FL
Disclosures
TM declares that he has no competing interests.
Alexander Spratt, MBBCh, MRCOphth
Specialist Registrar
Moorfields Eye Hospital
Visiting Lecturer
City University
London
UK
Disclosures
AS has received research funding from Allergan.
Differentials
- Ischemic optic neuropathy
- Retinal detachment (RD)
- Choroidal neovascularization (CNV)
More DifferentialsGuidelines
- Retina summary benchmarks - 2023
- Retinal vein occlusion (RVO) guidelines
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