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A - MSRA Ophthalmology [14] > [1] Retinal Venous Occlusion > Flashcards

[1] Retinal Venous Occlusion Flashcards

1
Q

What is retinal venous occlusion?

A

An interruption of the normal venous drainage from the retinal tissue

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2
Q

What can become occluded in retinal venous occlusion?

A
  • Central retinal vein

- Branch of the central retinal vein

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3
Q

What are the two possible (and sometimes overlapping) types of central retinal venous occlusion?

A
  • Non-ischaemic CRVO

- Ischaemic CRVO

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4
Q

What is non-ischaemic CRVO?

A

A milder form of the disease that may resolve fully with a good visual outcome

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5
Q

What percentage of CRVO’s are non-ischaemic in nature?

A

75%

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6
Q

What is the risk of non-ischaemic central retinal venous occlusion?

A

It can progress to become ischaemic type

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7
Q

What can occur as a result of ischaemic central retinal venous occlusion?

A

Patient may be left with neovascular glaucoma and painful eye with severe visual impairment

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8
Q

Is central retinal venous occlusion or branched retinal venous occlusion more common and by how much?

A

Branched retinal venous occlusion is 3 times as common as central

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9
Q

How are branched retinal venous occlusions further classified?

A

Whether the affected vein is a major, minor or peripheral vessel

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10
Q

What is it called when (uncommonly) a vein that drains half the retina is affected?

A

Hemiretinal vein occlusion

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11
Q

What is the most common cause of retinal venous occlusion?

A

Thrombus formation

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12
Q

What are some less common causes of retinal venous occlusion?

A
  • Disease of the vessel wall

- External compression of the vein

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13
Q

What happens to the blood as a result of retinal venous occlusion?

A

There is a backlog and stagnation which combines with hypoxia to result in extravasation of constituents causing further compression and a vicious circle is produced

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14
Q

What is stimulated if there is ischaemic damage to the retina?

A

Increased production of vascular endothelial growth factor (VEGF)

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15
Q

What does VEGF cause?

A

Neovascularisation

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16
Q

What can neovascularisation lead to?

A
  • Haemorrhage

- Neovascular glaucoma

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17
Q

Why can neovascularisation lead to haemorrhage?

A

As the new vessels are of poor quality

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18
Q

What is neovascular glaucoma?

A

Where new blood vessels grow into the aqueous drainage system and cause blockage

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19
Q

What are the risk factors for retinal venous occlusion?

A
  • Hypertension
  • DM
  • Hyperlipidaemia
  • Smoking
  • Obesity
  • Raised IOP
  • Inflammatory disease e.g. sarcoidosis
  • Hyperviscosity states e.g. myeloma
  • Thrombophilic disease
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20
Q

What does presentation of branch retinal venous occlusion largely depend upon?

A

Amount of compromise to the macular drainage

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21
Q

What does the extent of the effect on macular drainage influence?

A

The effect on visual acuity

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22
Q

What is the most common presentation of branch retinal venous occlusion?

A
  • Unilateral, painless blurred vision
  • Metamorphopsia
  • Field defect
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23
Q

What is metamorphopsia?

A

Image distortion

24
Q

What direction is the field defect typically in branch retinal venous occlusion?

A

Altitudinal

25
Q

When may branch retinal venous occlusion be asymptomatic?

A

In peripheral vein disease

26
Q

What will fundoscopy show in branch retinal venous occlusion?

A
  • Vascular dilatation and tortuosity of affected vessels

- Associated haemorrhage of affected area only

27
Q

What is the typical presentation of a patient with central retinal venous occlusion?

A

Sudden unilateral painless loss of vision or blurring

28
Q

When do the visual symptoms of central retinal venous occlusion often start?

A

Upon waking

29
Q

What can be seen on examination in non-ischaemic central retinal venous occlusion?

A
  • Mild or absent afferent pupillary defect
  • Widespread dot-blot and flame haemorrhages
  • Some disc oedema
30
Q

What can be seen on examination in ischaemic central retinal venous occlusion?

A
  • Severe visual impairment
  • Marked RAPD
  • Fundus looks smaller to non-ischaemic picture, disc oedema is more severe
  • Haemorrhages in fundus in blood-storm pattern
  • Cotton wool spots
31
Q

What can be associated with ischaemic central retinal venous occlusion and can sometimes be seen on examination?

A

Retinal detachment

32
Q

What are investigations used for in retinal venous occlusion?

A

To identify underlying system problems

33
Q

What test can be used in retinal venous occlusion to identify any underlying causes?

A
  • BP
  • Blood glucose and lipids
  • FBC and ESR
  • Plasma protein electrophoresis
  • ECG
34
Q

What tests may be needed in atypical cases e.g. retinal venous occlusion in a younger patient?

A
  • Thrombophilia screen
  • CRP
  • Auto-antibodies
35
Q

What investigations are made for retinal venous occlusion in the eye clinic?

A
  • Fluorescein angiogram
  • Measurement of IOP
  • Optical coherence tomography
36
Q

What can fluorescein angiogram be used for in retinal venous occlusion?

A
  • Confirm diagnosis
  • Assess for complications
  • Evaluate retinal capillary nonperfusion, neovascularisation and oedema
37
Q

What can OCT be used for in retinal venous occlusion?

A

Measure the retina and detect macular oedema

38
Q

What are the differentials for retinal venous occlusion?

A
  • Diabetic retinopathy
  • Other causes of sudden unilateral visual loss
  • Other causes of macular oedema
39
Q

What are some other causes of sudden unilateral visual loss (other than retinal venous occlusion)?

A
  • Retinal detachment

- Retinal artery occlusion

40
Q

How is uncomplicated branch retinal venous occlusion managed?

A

With observation and management of underlying conditions

41
Q

What underlying conditions should be managed in branch retinal venous occlusion?

A
  • Hypertension
  • Hyperlipidaemia
  • DM
42
Q

What should patients with uncomplicated branch retinal venous occlusion be monitored for?

A
  • Macular oedema

- Neovascularisation

43
Q

If macular oedema develops in branch retinal venous occlusion, how should it be managed first line?

A

Intravitreal VEGF inhibitors

44
Q

If macular oedema persists in branch retinal venous occlusion despite several monthly injections of VEGF inhibitors what should be used?

A

Intravitreal corticosteroid (dexamethasone) as well as anti-VEGF therapy

45
Q

If 3 months of intravitreal treatment is not effective at reducing macular oedema, what can be used?

A

Grid-pattern laser photo-coagulation

46
Q

Are there treatments for central retinal venous occlusion?

A

Not really, just manage risk factors and complications

47
Q

What is the aim if neovascular glaucoma occurs due to central retinal venous occlusion?

A

Keep the eye pain free

48
Q

What is the management of uncomplicated central retinal venous occlusion?

A

Manage underlying conditions and observe

49
Q

Which patients with central retinal venous occlusion should receive more regular observation?

A

Those with ischaemic central retinal venous occlusion

50
Q

How should macular oedema be managed in central retinal venous occlusion?

A

As in branch retinal venous occlusion

51
Q

What is the treatment for neovascular glaucoma in central retinal vein occlusion?

A
  • Pan-retinal photocoagulation

- Manage IOP

52
Q

How can IOP be managed in neovascular glaucoma?

A
  • Ophthalmic β-blockers

- Carbonic anhydrase inhibitors

53
Q

What are the complications of branch retinal venous occlusion?

A

Similar to retinal artery occlusion

54
Q

What are the complications of central retinal venous occlusion?

A
  • Neovascularisation and secondary glaucoma or vitreous haemorrhage
  • Macular oedem
  • Lamellar or full thickness macular hole
  • Permanent macular degeneration
  • Optic atrophy
55
Q

What will most patients who have had long-term macular oedema have as a result?

A

Reduced central vision

A - MSRA Ophthalmology [14] (16 decks)

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