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retinal vein occlusion
Etiology:
- risk factors
- atherosclerosis
- diabetes mellitus
- hypertension
- glaucoma
- macular edema
- vitreous hemorrhage
- hyperviscosity syndrome (younger patients)
- polycythemia vera
- sickle cell anemia
- leukemia
Epidemiology:
- affects mostly elderly
Pathology:
- thrombus formation in retinal vein
- reduced venous outflow
- macular edema may result from hydrostatic pressure & leakage of fluid
- glaucoma may result from angiogenesis in response to retinal vein occlusion
Clinical manifestations:
- sudden onset blurry vision or vision loss in all or part of one eye
- painless [3]
- central retinal vein occlusion generally presents as painless blurred monocular vision
- branch retinal vein occlusion may be asymptomatic or present with scotoma or visual field defect
- afferent pupillary defect may be present
- pupil does not react to light
- pupil reacts to light in contralateral eye [3]
Laboratory:
- tests for diabetes
- serum glucose
- hemoglobin A1c
- lipid panel
- evaluation for hyperviscosity syndrome
- complete blood count
- serum protein
- serology for cryoglobulins
Special laboratory:
- ophthalmoscopy
- optic disc swelling
- dilated & tortuous veins
- flame-shaped retinal hemorrhage
- cotton wool spots [3]
- intraocular pressure
- pupil reflex response
- slit lamp examination
- visual field examination
- visual acuity testinn
Management:
- no generally accepted acute management [3]
- control risk factors to prevent recurrence
- focal laser therapy for macular edema
- VEGF inhititor to prevent neovascularization is experimental
- I5863, temsirolimus, semaxinib
- prognosis:
- patients often regain useful vision
- vision rarely returns to normal
- depends on degree on visual impairment at the onset of symptoms [3]
Related
retinal vein
Specific
branch retinal vein occlusion (BRVO)
central retinal vein occlusion (CRVO)
General
retinal vascular occlusion
venous disease; venopathy
References
- PubMed Health: Retinal vein occlusion
Central retinal vein occlusion; Branch retinal vein occlusion;
CRVO; BRVO
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004583/
- Fonrose M
eMedicine (Medscape): Retinal Vein Occlusion
http://emedicine.medscape.com/article/798583-overview
- Medical Knowledge Self Assessment Program (MKSAP) 16, 18, 19.
American College of Physicians, Philadelphia 2012, 2018, 2022.