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Retinal vascular occlusions

Retinal vascular occlusions. Retinal venous and arterial occlusions are among the more common serious ophthalmic conditions presenting acutely. Should be always considered in the DDx of a pt with sudden painless loss of vision. Usually a manifestation of a systemic disease. Venous occlusion.

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Retinal vascular occlusions

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  1. Retinal vascular occlusions • Retinal venous and arterial occlusions are among the more common serious ophthalmic conditions presenting acutely. • Should be always considered in the DDx of a pt with sudden painless loss of vision. • Usually a manifestation of a systemic disease.

  2. Venous occlusion • Pathogenesis: • Central retinal vein occlusion (CRVO) may result from: 1- Abnormality of the blood itself (the hyperviscosity syndromes and abnormalities in coagulation). 2- An abnormality of the venous wall (inflammation). 3- An increased ocular pressure.

  3. History: • The patient complains of a sudden partial or complete loss of vision although onset may be less acute than that of arterial occlusion. • This loss of vision occurs when the involved segment of retina includes the macula* • Variability of the initial fall in visual acuity–- ranging from 6/9 to hand movm. • Signs: • These contrast markedly with those of arterial occlusion. • There is marked haemorrhage and great tortuosity and swelling of the veins. • The optic disc appears swollen. • Macular edema may be seen.

  4. Signs cont. • Branch retinal vein occlusion may originate at the crossing point of an arteriole and a vein where the arteriole has been affected by arteriosclerosis associated with hypertension (a/v nipping)  Subsequently: 1- Abnormal new vessels may grow on the retina and optic disc, causing vitreous haemorrhage. This happens if the retina has become ischaemic as a result of the vein occlusion (an ischaemic retinal vein occlusion). 2- In ischaemic retinal vein occlusion abnormal new vessels may grow on the iris(rubeosis) causing rubeotic glaucoma*.

  5. Investigation: • Vascular and haematological work-up to exclude increased blood viscosity. • CRVO is also associated with raised ocular pressure, diabetes and hypertension. • Treatment: • Retinal laser treatment is given if the retina is ischaemic to prevent the development of retinal and iris new vessels. • Laser treatment may improve vision in some patients with a branch retinal vein occlusion by reducing macular oedema.

  6. Prognosis: • The vision is usually severely affected in central, and often in branch vein occlusion and usually does not improve. • Younger patients may fare better, and there may will be some visual improvement.

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