Ophthalmology · MU Sofia

63. Acute vascular disorders of the retina

Covers retinal vein occlusion, starting with its causes and a split between central and branch forms, then the central type's non-ischaemic and ischaemic variants with their stages, complications and treatment, and branch occlusion. It then moves to retinal artery occlusion, its causes, central and branch forms, typical signs such as the cherry-red macula, and emergency management.

Inside: 4 sections · 5 labelled pictures · 15 flashcards · 4 min

Topic 63 of 91 in the MU Sofia syllabus for Ophthalmology (Medicine, Year 4). The free AceMed note covers it in 4 sections, about 526 words (4 min of reading), with 15 flashcards.

In this note

  1. Retinal Vein occlusion
  2. Topic 40
  3. Retinal artery Occlusion
  4. Topic 41

Topic 40

= more common than artery occlusion; typically in 60 or above men

Causes

  • Sclerotic retinal artery putting pressure on the vein
  • Hyperviscosity of blood (polycythemia,hyperlipidemia&maccroglobulinemia)
  • Periphlebitis retinae Raised IOP (thus more common in open-angle glaucoma)
  • Local causes (orbital cellulitis , facial erysipelas& cavernous sinus thrombosis )
  • Classification :it may affect Central retinal vein (non-ischaemic or ischaemic) or branch retinal vein

Central retinal vein occlusion

1. Non-ischaemic CRVO

(More common than Ischaemic; 75%) aka venous stasis retinopathy

  • Mild to moderate loss vision
  • Early cases → mid venous congestion with many twists & turns + a few flame-shaped haemorrhages more in periphery , mild/no macular oedema +mild papilloedema
  • late stages → sheath formation around the main veins & cilioretinal collateral around the disc with partially absorbed retinal haemorrhages chronic cystoid oedema
  • Treatment : usually not required with 50% gain normal vision Visual loss in patients is due to chronic cystoid macular oedema

2. Ischaemic CRVO (haemorrhagic retinopathy)

  • Sudden complete occlusion of central retinal vein with sudden visual loss
  • Early→ massive engorgement ,congestion + twist & turn of retinal veins + massive haemorrhage giving splashed tomato appearance ,+ many soft exudate + papilloedema Macular area is full of haemorrhages and severely oedematous
  • Late : sheath formation around veins +collaterals around disc , neovascularisation at disc/periphery , macula→ obvious pigmentary changes + chronic cystoid oedema Complications: neovascular glaucoma 50%, Rubeosis iridis, sometimes Vitreous haemorrhage and proliferative retinopathy Treatment: Panretinal photocoagulation after intraretinal blood is absorbed

Differential CRVO: visual field defect & relative afferent pupillary defect

Branch retinal vein occlusion: more common than central vein occlusion

  • At main branch at disc margin causing hemispheric occlusion, major branch away from disk at A-V crossing → quadrantic occlusion and small macular or peripheral branch occ.
  • Oedema& haemorrhage limited to area; vision defects if macular is involved Complications: chronic macular oedema &neovasc.,
  • treatment: grid/scatter photocoagulation

Continue reading free

The whole note, all 4 sections, is free with an AceMed account, with its 15 flashcards. Premium adds flashcard recall, highlights and Ask AI.

Start freeAlready a member? Open the note