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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
When may branch retinal venous occlusion be asymptomatic?
In peripheral vein disease
26
What will fundoscopy show in branch retinal venous occlusion?
- Vascular dilatation and tortuosity of affected vessels | - Associated haemorrhage of affected area only
27
What is the typical presentation of a patient with central retinal venous occlusion?
Sudden unilateral painless loss of vision or blurring
28
When do the visual symptoms of central retinal venous occlusion often start?
Upon waking
29
What can be seen on examination in non-ischaemic central retinal venous occlusion?
- Mild or absent afferent pupillary defect - Widespread dot-blot and flame haemorrhages - Some disc oedema
30
What can be seen on examination in ischaemic central retinal venous occlusion?
- 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
What can be associated with ischaemic central retinal venous occlusion and can sometimes be seen on examination?
Retinal detachment
32
What are investigations used for in retinal venous occlusion?
To identify underlying system problems
33
What test can be used in retinal venous occlusion to identify any underlying causes?
- BP - Blood glucose and lipids - FBC and ESR - Plasma protein electrophoresis - ECG
34
What tests may be needed in atypical cases e.g. retinal venous occlusion in a younger patient?
- Thrombophilia screen - CRP - Auto-antibodies
35
What investigations are made for retinal venous occlusion in the eye clinic?
- Fluorescein angiogram - Measurement of IOP - Optical coherence tomography
36
What can fluorescein angiogram be used for in retinal venous occlusion?
- Confirm diagnosis - Assess for complications - Evaluate retinal capillary nonperfusion, neovascularisation and oedema
37
What can OCT be used for in retinal venous occlusion?
Measure the retina and detect macular oedema
38
What are the differentials for retinal venous occlusion?
- Diabetic retinopathy - Other causes of sudden unilateral visual loss - Other causes of macular oedema
39
What are some other causes of sudden unilateral visual loss (other than retinal venous occlusion)?
- Retinal detachment | - Retinal artery occlusion
40
How is uncomplicated branch retinal venous occlusion managed?
With observation and management of underlying conditions
41
What underlying conditions should be managed in branch retinal venous occlusion?
- Hypertension - Hyperlipidaemia - DM
42
What should patients with uncomplicated branch retinal venous occlusion be monitored for?
- Macular oedema | - Neovascularisation
43
If macular oedema develops in branch retinal venous occlusion, how should it be managed first line?
Intravitreal VEGF inhibitors
44
If macular oedema persists in branch retinal venous occlusion despite several monthly injections of VEGF inhibitors what should be used?
Intravitreal corticosteroid (dexamethasone) as well as anti-VEGF therapy
45
If 3 months of intravitreal treatment is not effective at reducing macular oedema, what can be used?
Grid-pattern laser photo-coagulation
46
Are there treatments for central retinal venous occlusion?
Not really, just manage risk factors and complications
47
What is the aim if neovascular glaucoma occurs due to central retinal venous occlusion?
Keep the eye pain free
48
What is the management of uncomplicated central retinal venous occlusion?
Manage underlying conditions and observe
49
Which patients with central retinal venous occlusion should receive more regular observation?
Those with ischaemic central retinal venous occlusion
50
How should macular oedema be managed in central retinal venous occlusion?
As in branch retinal venous occlusion
51
What is the treatment for neovascular glaucoma in central retinal vein occlusion?
- Pan-retinal photocoagulation | - Manage IOP
52
How can IOP be managed in neovascular glaucoma?
- Ophthalmic β-blockers | - Carbonic anhydrase inhibitors
53
What are the complications of branch retinal venous occlusion?
Similar to retinal artery occlusion
54
What are the complications of central retinal venous occlusion?
- Neovascularisation and secondary glaucoma or vitreous haemorrhage - Macular oedem - Lamellar or full thickness macular hole - Permanent macular degeneration - Optic atrophy
55
What will most patients who have had long-term macular oedema have as a result?
Reduced central vision

A - MSRA Ophthalmology [14] (16 decks)

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