Retinal vein occlusion

Case history

A 65-year-old man with a history of hypertension and hypercholesterolemia notices sudden, painless vision loss in his right eye. The vision loss is limited to the superonasal quadrant of his visual field. He first noticed the visual field loss approximately 6 weeks ago. For the past 2 weeks, however, he has started to have blurred vision centrally, making reading difficult.

Other presentations

RVO can sometimes present with only a vitreous hemorrhage. The patient typically reports unilateral floaters, shaped like cobwebs or strands, that gradually increase in number and size. These symptoms can occur in the absence of trauma, diabetes mellitus, or photopsias, making other causes of vitreous hemorrhage less likely.

Other populations at risk include young women of childbearing age, who are often taking birth control pills; patients with hypercoagulable states such as the antiphospholipid antibody syndrome or hyperhomocysteinemia; and patients who have a history of systemic vasculitis such as systemic lupus erythematosus (SLE) or sarcoidosis.