History and exam

Key diagnostic factors

common

sudden, painless vision loss

Whole visual field in CRVO, single quadrant in BRVO, altitudinal in hemiretinal vein occlusion (HRVO).

optic nerve head edema

Present in acute and subacute CRVO.

intraretinal hemorrhage

Present in region of retina affected by RVO: all 4 quadrants in CRVO, 1 quadrant in BRVO, superior or inferior hemisphere in HRVO.[Figure caption and citation for the preceding image starts]: Optical coherence tomogram, right eye; central retinal vein occlusion; large cystoid thickening throughout maculaFrom the personal library of Dr Aziz Khanifar [Citation ends].com.bmj.content.model.Caption@22ca987[Figure caption and citation for the preceding image starts]: Color photograph, right eye; central retinal vein occlusion; multiple intraretinal hemorrhages in each quadrantFrom the personal library of Dr Aziz Khanifar [Citation ends].com.bmj.content.model.Caption@7d9bb8bb

venous tortuosity and dilation

Present in region of retina affected by RVO: all 4 quadrants in CRVO, 1 quadrant in BRVO, superior or inferior hemisphere in HRVO.

uncommon

collateral vessel formation

Can be found in region of optic nerve in chronic CRVO or crossing the horizontal raphe in chronic BRVO.

Other diagnostic factors

common

age >65 years

71% of patients affected by central retinal vein occlusion (CRVO) and 77% of patients affected by branch retinal vein occlusion (BRVO) are >65 years of age.[6]

neovascularization

Can be present in iris, angle, or retina as a complication of RVO.

vitreous hemorrhage

Associated with neovascularization, a complication of RVO.

macular edema

Present as a complication in RVO.

uncommon

floaters

Associated with vitreous hemorrhage, a complication of RVO.

painful, red eye

Associated with neovascular glaucoma, a complication of RVO.

visual acuity

Visual acuity worse than 20/200 is a sign of an ischemic CRVO.[9]​​​[10]​

relative afferent pupillary defect

The presence of a relative afferent pupillary defect is a sign of an ischemic CRVO.​[9][10]​​​[25]

elevated intraocular pressure

Intraocular pressure may be elevated in patients with glaucoma, which is a risk factor for RVO.[22]

Risk factors

strong

atherosclerosis

Leads to contraction of the common adventitia, turbulent blood flow, endothelial cell injury, and thrombotic venous occlusion.[6]

systemic hypertension

Risk factor for atherosclerosis.[6] In one meta-analysis, hypertension was the strongest risk factor for RVO.[2]

diabetes mellitus

Risk factor for atherosclerosis; associated with increased incidence of RVO in older patients.[6] 

hyperlipidemia

Risk factor for atherosclerosis; incidence of hyperlipidemia is higher in patients with RVO.[16]

history of smoking

Risk factor for atherosclerosis; associated with increased incidence of RVO.[6] 

cardiovascular disease

Associated with increased incidence of RVO in older patients.

glaucoma

Associated with increased incidence of RVO in older patients.

increased body mass index at 20 years of age

Higher incidence of RVO in patients who had an increased body mass index (>25 g per square meter) as young adults.

increased serum alpha-2 globulin

Higher incidence of RVO in patients with an increased serum alpha-2 globulin (>1.0 g/dl).

short axial length

Axial length usually measured by ultrasound in A-scan mode. However, there is no fixed threshold for short length.[3]

age >65 years

The main risk factor for both central retinal vein occlusion and branch retinal vein occlusion is older age.[4]​ Over 70% of cases of RVO are seen in patients ages ≥65.[6]

weak

activated protein C resistance

Associated with increased incidence of RVO in younger patients.[17][18]

factor V Leiden

Associated with increased incidence of RVO in younger patients.[17][18]

hypercoagulable state

Associated with increased incidence of RVO in younger patients.[17][19][20][21]

protein S deficiency

Associated with increased incidence of RVO in younger patients.[20][21]

antithrombin III deficiency

Associated with increased incidence of RVO in younger patients.[20][21]

hyperhomocysteinemia

Associated with increased incidence of RVO in younger patients.[20][21]

vasculitis

Associated with increased incidence of RVO in younger patients.[20][21]

Use of this content is subject to our disclaimer