II. Epidemiology
- Common cause of Vision Loss in older adults
- However, also common in young adults (one third of cases in age <45 years old)
- Contrast with Central Retinal Artery Occlusion in older adults
III. Pathophysiology
- Venous Occlusion results in Retinal edema, Hemorrhage and vascular leak
- Venous Thromboembolism may result from vessel damage or Hypercoagulable state
IV. Risk Factors
- Hypercoagulable State
- Age over 55 years
- Hypertension
- Hyperlipidemia
- Diabetes Mellitus
- Tobacco Abuse
V. Types
- Nonischemic Central Retinal Vein Occlusion (75% of cases)
- Progresses to ischemic types in 15% of patients within 4 months (34% within 3 years)
- Sudden painless, unilateral visual blurring (better than 20/200)
- Mild funduscopic findings
- No Relative Afferent Pupillary Defect
- Ischemic Central Retinal Vein Occlusion
- Sudden painless, severe unilateral visual loss (worse than 20/200)
- Relative Afferent Pupillary Defect
- Marked funduscopic changes
VI. Symptoms
- Monocular painless visual loss
- May initially present with transient episodes of mild Blurred Vision
VII. Signs
- Decreased Visual Acuity
- Afferent Pupillary Defect may be present (esp. ischemic CRVO)
-
Funduscopic Exam
- Retinal veins dilated and tortuous
- Blood streaked Retina or flame-shaped Hemorrhages (esp. in ischemic type)
- Diffuse Retinal Hemorrhages radiating from Optic Disc ("Blood and thunder Retina")
- Cotton wool patches may be present (esp. with Hypertension)
VIII. Differential Diagnosis
IX. Management
- Urgent Ophthalmology Consultation
- Antivascular endothelial growth factors
- Corticosteroids
- Photocoagulation (if neovascularization)
- No specific management to alter Hemorrhages
- Management is focused on reducing longerterm complications of Retinopathy including Glaucoma
- Non-urgent laser photocoagulation may be needed in some cases
- Management is also focused on reducing risk of disease progression
- Optimize management of Hypertension and Diabetes Mellitus
- Optimize hydration
- Decrease Intraocular Pressure (e.g. Acetazolamide)
-
Patient Instructions
- Return immediately for Decreased Visual Acuity
- Follow-up after initial ophthalmology evaluations
- Follow-up ophthalmology in 3 months (monthly for at least 6 months if ischemic CRVO)
X. Prognosis
- For those who do not convert to ischemic CRVO, 50% will recover nearly normal Vision
XI. Complications
XII. References
- Hartmann (2016) Crit Dec Emerg Med 30(6): 3-11
- Sales, Patel and Patel (2019) Crit Dec Emerg Med 33(12): 3-13
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Related Studies
| Concepts | Disease or Syndrome (T047) |
| MSH | D012170 |
| ICD9 | 362.35 |
| ICD10 | H34.81 |
| SnomedCT | 193378003, 68478007 |
| English | CRVO - Central ret vein occln, CRVT - Central ret vein thromb, Centr retinal vein thrombosis, central retinal vein occlusion, occlusion of central retinal vein (diagnosis), occlusion of central retinal vein, occlusion of central retinal vein (physical finding), Central retinal vein occlusion, Cent retinal vein occlus, central retinal thrombosis vein, central occlusions retinal vein, retinal central vein occlusion, CRVO - Central retinal vein occlusion, CRVT - Central retinal vein thrombosis, Central retinal vein thrombosis, Central retinal vein occlusion (disorder) |
| Dutch | centrale retinavene occlusie |
| German | Verschluss der zentralen Netzhautvene |
| Italian | Occlusione della vena centrale della retina |
| Portuguese | Oclusão da veia central da retina |
| Spanish | Oclusión de la vena central de la retina, oclusión de la vena retiniana central (trastorno), oclusión de la vena retiniana central |
| Japanese | 網膜中心静脈閉塞, ﾓｳﾏｸﾁｭｳｼﾝｼﾞｮｳﾐｬｸﾍｲｿｸ |
| French | Occlusion de la veine centrale de la rétine, OVCR (Occlusion de la Veine Centrale de la Rétine) |
| Czech | Okluze centrální retinální vény |
| Hungarian | Vena centralis retinae elzáródás |
