1. RETINAL VEIN OCCLUSION
Epidemiology
51% >65y
10-15% <45y
ν Afro-caribbean and Asian descent in UK
Pathogenesis
Primary retinal venous disease/ endothelium
Thrombus secondary event (Hypercoaguability)

2. AETIOLOGICAL CONDITIONS
COMMON
SYSTEMIC
LOCAL
1. BP
Glaucoma
2.Hyperlipidemia
Trauma
3.DM
Orbital lesions
4.Smoking
Oedema-drusen optic disc
RARER
1.MM and Waldestrom
6.Secondary causes of 1, 2, 3 such as acromegaly cushing, hypothyroidism
2.CRF
3.Vasculitis
4.Thrombotic disorders
5. Oral contraceptives (oestrogen)/ no HRT

3. DIAGNOSIS
Painless loss of vision- unilateral
Asymptomatic

4. BRVO
Arteriovenous crossings
Macular branch (DD from diabetic maculopathy)
ACUTE
CHRONIC
Haemorrhages
Venous sheathing
Retinal oedema
Exudates
Cotton wool spots
Collaterals
Tortuous veins
CMO
>5 dd non-perfusion: NVE

5. CRVO
ACUTE
CHRONIC
Dilated tortuous retinal veins
Swollen optic disc
Intraretinal haemorrhage
Cotton wool spots
Retinal oedema
Sheathing of veins
Absorption of haemorrhage
Disc collaterals
Macular oedema

6. MECHANISMS OF VISUAL LOSS
Ischaemic (direct- indirect)
Exudative (macular oedema)
30% non-isch. Convert to ischaemic type first 4/12
Eyes at High Risc for Ischaemic Complications
1.RAPD
2.  VA
3. FFA >10DD, 5-10 DD
4.Cotton wool spots >10, 5-10
5. Deep dark haem. (infarct)
6. Elderly ( rubeosis)

7. DIFFERENTIAL DIAGNOSIS
1.Accelerated hypertension
2.DM
3.Slow-flow retinopathy
4.Peripapillary telangiectasia
5. AION
6.Lupus/ radiation retinopathy
7. CMV retinitis
8.Ocular ischaemic syndrome

8. MEDICAL INVESTIGATIONS
ALL PATIENTS
FBC, ESR, U&E, LFT, GLC, Lipid profile
Protein electrophoresis
ECG
TFT
MORE SPECIALISED
CXR
Cardiolipin, Lupus anticoagulant
CRP, ACE, FTA-ABS
RF, ANA, DNA, ANCA
MRI: orbit, brain

9. MANAGEMENT
OCULAR
BRVO
Argon laser for macular oedema if foveal vasculature intact (FFA), VA 6/12-6/60 3-6/12 after the initial event
Sectoral PRP for proliferative complications or if areas of non-perfusion >5DD
FU: 6/52, up to 2years after (collaterals)

10. CRVO Prevention of neovascularisation Grid: no benefit
FFA and Laser: haemorrhages sufficiently resolved
Monthly FU/ total of 2years
>40DD: PRP
10-40DD: no
<10 (non-ischaemic): no
Non-ischaemic cases convert to ischaemic
13%: 6/12
18%: 18/12
CHECK RAPD ALWAYS IN FU

11. MEDICAL
Maximise visual outcome
 cardiovascular morbidity/ mortality (risk factors)
Prevent recurrence to other eye (15% over 5 years) + Aspirin/ dipyridamole