Retinal vein thrombosis

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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205 Retinal vein thrombosis

Instruction

Examine these patient eyes, including the fundus.

Salient features

History

• Age: central retinal vein occlusions arise in 0·1–0·4% and branch retinal vein occlusions in 0·6–1·1% of adults aged ≥40 years

• Branched retinal vein occlusion: decreased vision, floaters suggest vitreal haemorrhage

• Central retinal vein occlusion: loss or decreased vision, headache (associated increase in intraocular pressure), floaters

• History of hypertension, diabetes, glaucoma, multiple myeloma or macroglobulinaemia.

Examination

Patient 1

Central retinal vein occlusion (Fig. 205.1), the occlusion is behind the cribriform plate:

• Multiple retinal and preretinal haemorrhages surround the optic nerve head. there is marked dilatation and tortuosity of the veins, hyperaemia or oedema of the nerve head and soft exudates: ‘blood and thunder’ appearance
• Visual acuity is only slightly reduced.
image

Fig. 205.1 Central retinal vein thrombosis.

Patient 2

• Branch vein occlusion (Fig. 205.2), the occlusion is in front of the cribriform plate:

• Occlusion occurs just distal to the arteriovenous crossing and haemorrhages can be seen surrounding the occluded vein; the superior temporal vein is most commonly involved
• May cause a quadrantic field defect.
image

Fig. 205.2 Branch retinal vein thrombosis.

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