Retinal Vein Occlusion
- Updated by Clement C. Chow, M.D.
What is a retinal vein occlusion?
A retinal vein occlusion means that a vein in the retina of the eye has become blocked. The retina is the light sensing tissue at the back of our eye. The veins drain blood out of the retina and return it to the heart. Blockage or occlusion in the vein prevents adequate blood flow in the affected area. The walls of the vein leak blood and excess fluid into the retina.
What are the types of retinal vein occlusion?
There are two types of retinal vein occlusion:
Central Retinal Vein Occlusion (CRVO)
The main retinal vein is blocked. Blood flow is poor throughout the entire retina. The amount of visual loss varies in younger people but is often severe in older people.
Branch Retinal Vein Occlusion (BRVO)
A smaller branch of the main retinal vein is blocked. Only the part of the retina drained by this branch vein is damaged. Vision loss varies but is not as severe as in CRVO.
Who is at risk for a retinal vein occlusion?
Retina vein occlusions are more common in people who have:
Glaucoma (abnormal eye pressure)
Age-related vascular (blood vessel) disease
high blood pressure
What are the symptoms of retinal vein occlusion?
Blurred vision is the main symptom of retinal vein occlusion. It occurs when the excess fluid leaking from the vein collects in the macula. The macula is the central area of the retina which is responsible for our central, detailed vision. If the macula swells with excess fluid (macular edema), vision blurs. Floaters can appear as spots which interfere with vision. When retinal blood vessels are not working properly, the retina may grow abnormal blood vessels (neovascularization) which are fragile. They can bleed or leak fluid into the vitreous, the gel-like fluid that fills the center of the eye, causing the floaters. Pain in the eye sometimes occurs as a complication of severe CRVO. It is caused by excessive eye pressure called neovascular glaucoma.
What tests might the doctor order?
After a complete eye examination, your ophthalmologist may order blood tests and/or a test of the retinal circulation called fluorescein angiography. A dye (fluorescein) is injected into your arm and special photos are taken of the inside of your eye as the dye passes through the blood vessels. Optical coherence tomography (OCT) which shows a cross-section of the retina may also be done to see if there is any thickening or swelling. Your ophthalmologist may also suggest a visit to your family physician to discover and manage any associated medical problems.
What treatment is available?
There is no cure for retinal vein occlusion. Your ophthalmologist may recommend a period of observation, since hemorrhages and excess fluid may subside on their own (usually in younger people only).
The main goal of treatment is to stabilize vision by sealing off leaking blood vessels that interfere with the proper function of the macula. Treatment with injections of Avastin, Lucentis, or Eylea in the eye is now the standard of care for treating macular edema. Ozurdex, a long-acting steroid, is another FDA approved treatment.
Scatter (pan-retinal) laser treatment can be used to help regress abnormal blood vessels and prevent bleeding or neovascular glaucoma. In this type of surgery, the Eye M.D. may make hundreds of small burns to the peripheral retina. It may require two or more treatments to complete the process. However, it does not remove a hemorrhage or cure neovascular glaucoma once they are already present. It is best to treat people at risk for these complications before they occur. Your Eye M.D. will decide whether laser surgery is appropriate for you.
Copyright 1992, American Academy of Ophthalmology. Reprinted by permission, updated 2013 by Clement C. Chow, M.D.
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