Retinal vein occlusion

Last reviewed: 29 Oct 2022
Last updated: 20 Jul 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • sudden, painless vision loss
  • optic nerve head oedema
  • intra-retinal haemorrhage
  • venous tortuosity and dilation
  • collateral vessel formation
More key diagnostic factors

Other diagnostic factors

  • age >65 years
  • neovascularisation
  • vitreous haemorrhage
  • macular oedema
  • floaters
  • painful, red eye
  • visual acuity
  • relative afferent pupillary defect
  • elevated intra-ocular pressure
Other diagnostic factors

Risk factors

  • atherosclerosis
  • systemic hypertension
  • diabetes mellitus
  • hyperlipidaemia
  • history of smoking
  • cardiovascular disease
  • glaucoma
  • increased body mass index at 20 years of age
  • increased serum alpha-2 globulin
  • short axial length
  • activated protein C resistance
  • factor V Leiden
  • hypercoagulable state
  • protein S deficiency
  • antithrombin III deficiency
  • hyperhomocysteinaemia
  • vasculitis
  • age >65 years
More risk factors

Diagnostic investigations

1st investigations to order

  • fluorescein angiogram for confirmation of diagnosis
More 1st investigations to order

Investigations to consider

  • fluorescein angiogram for assessment of complications
  • optical coherence tomography
  • electroretinography
More investigations to consider

Treatment algorithm

ACUTE

CRVO: uncomplicated

CRVO with macular oedema

CRVO with neovascularisation

BRVO or HRVO: uncomplicated

BRVO or HRVO with macular oedema

BRVO or HRVO with neovascularisation

Contributors

Authors

Aziz A. Khanifar, MD
Aziz A. Khanifar

Vitreoretinal Surgeon

The Retina Group of Washington

Silver Spring

MD

Disclosures

AAK has been reimbursed by Genentech for participating in an advisory board. AAK has been reimbursed by Novartis as a speaker.

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.

  • Retinal vein occlusion images
  • Differentials

    • Ischaemic optic neuropathy
    • Retinal detachment (RD)
    • Choroidal neovascularisation (CNV)
    More Differentials
  • Guidelines

    • Retinal vein occlusion (RVO) guidelines
    • Retinal vein occlusions preferred practice pattern
    More Guidelines
  • Patient leaflets

    Diabetes: what can I do to keep healthy?

    Glaucoma (open angle)

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer