Central retinal vein occlusion (CRVO) is a differential for sudden painless loss of vision.

Risk factors

• increasing age
• hypertension
• cardiovascular disease
• glaucoma
• polycythaemia

Features

• sudden, painless reduction or loss of visual acuity, usually unilaterally
• fundoscopy
  • widespread hyperaemia
  • severe retinal haemorrhages - 'stormy sunset'

A key differential is branch retinal vein occlusion (BRVO) - this occurs when a vein in the distal retinal venous system is occluded and is thought to occur due to blockage of retinal veins at arteriovenous crossings. It results in a more limited area of the fundus being affected.

Fundoscopy showing branch retinal vein occlusion

Fundoscopy image showing a central retinal vein occlusion

Management

• the majority of patients are managed conservatively
• indications for treatment in patients with CRVO include:
  • macular oedema - intravitreal anti-vascular endothelial growth factor (VEGF) agents
  • retinal neovascularization - laser photocoagulation