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Clinical Summary

Patients are usually older individuals and complain of sudden, painless visual loss in one eye. The vision loss is usually not as severe as CRAO and may vary from normal to hand motion. Funduscopy in a classic, ischemic central retinal vein occlusion (CRVO) shows a “blood and thunder” fundus: hemorrhages (including flame, dot, or blot, preretinal, and vitreous) and dilation and tortuosity of the venous system. The arterial system often shows narrowing. The disk margin may be blurred. Cotton wool spots and edema may be seen.

FIGURE 3.14

Central Retinal Vein Occlusion. The amount of hemorrhage is the most striking feature in this photograph. Also note the blurred disk margin, the dilation and tortuosity of the venules, and the cotton wool spots. Retinal edema is suggested by blurring of the retinal details. (Photo contributor: Department of Ophthalmology, Naval Medical Center, Portsmouth, VA.)

Management and Disposition

Treatment is rarely effective in preventing or reversing the damage done by the occlusion and is directed toward systemic evaluation to identify and treat contributing factors, hopefully decreasing the chance of contralateral CRVO. Ophthalmologic evaluation is necessary to confirm the diagnosis, estimate the amount of ischemia, and follow the patient so as to minimize sequelae of possible complications such as neovascularization and neovascular glaucoma.

Pearls

  1. Sudden, painless visual loss in one eye should be evaluated promptly to determine its etiology.

  2. Look for the classic “blood and thunder” funduscopic findings.

  3. Consider the differential diagnosis of acute painful (glaucoma, retrobulbar neuritis) versus painless vision loss (CRAO, anterior ischemic optic neuropathy, retinal detachment, subretinal neovascularization, and vitreous hemorrhage).

FIGURE 3.15

Central Retinal Vein Branch Occlusion. The hemorrhage seen is limited to a sector of the fundus, indicating that a branch occlusion has occurred. There is less edema, and a large portion of the fundus is unaffected. (Photo contributor: Richard E. Wyszynski, MD.)

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