Which physical findings are characteristic of central retinal vein occlusion (CRVO)?

Updated: Apr 18, 2019
  • Author: Lakshmana M Kooragayala, MD; Chief Editor: Douglas R Lazzaro, MD, FAAO, FACS  more...
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Answer

Patients with central retinal vein occlusion (CRVO) should undergo a complete eye examination, including visual acuity, pupillary reactions, slit lamp examination of the anterior and posterior segments, undilated examination of the iris, gonioscopy, fundus examination with indirect ophthalmoscope, and fundus contact lens. [11] Note the following:

  • Visual acuity: Best-corrected vision always should be obtained. It is one of the important indicators of the final visual prognosis.

  • Pupillary reactions may be normal and may present with relative afferent pupillary reflex. If the iris has abnormal blood vessels, the pupil may not react.

  • Conjunctiva: Advanced stages may show congestion on conjunctival and ciliary vessels.

  • Cornea: Advanced stages may show diffuse corneal edema obscuring the visibility of internal structures.

  • The iris may be normal. Advanced stages may show neovascularization. These vessels are detected best on an undilated iris. Initially, the vessels may be seen around pupillary margins and peripheral iridectomy openings if present.

  • The anterior chamber angle is examined by gonioscopy. This is examined best in an undilated iris. Initially, it may show neovascularization with open angles and later show total peripheral anterior synechia and closed angles.

  • Fundus examination: Retinal hemorrhages may present in all 4 quadrants. Hemorrhages can be superficial, dot and blot, and/or deep. In some patients, hemorrhages may be seen in the peripheral fundus only. Hemorrhages can be mild to severe, covering the whole fundus and giving a "blood and thunder appearance." Note the images below.

    Scattered retinal hemorrhages in a patient with ce Scattered retinal hemorrhages in a patient with central retinal vein occlusion.
    Fundus of a patient with nonischemic central retin Fundus of a patient with nonischemic central retinal vein occlusion, showing few scattered peripheral fundus hemorrhages.
    Recent onset central retinal vein occlusion, showi Recent onset central retinal vein occlusion, showing extensive hemorrhages in the posterior pole and giving the "blood and thunder appearance."
  • Dilated tortuous veins: Veins may be dilated and tortuous, as shown in the image below.

    Patient with nonischemic central retinal vein occl Patient with nonischemic central retinal vein occlusion presented with dilated, tortuous veins and superficial hemorrhages.
  • Optic disc edema: The optic disc may be swollen during the early-stage disease. Note the images below.

    Central retinal vein occlusion showing significant Central retinal vein occlusion showing significant disc edema with dilated tortuous veins and scattered retinal hemorrhages.
    Fluorescein angiogram of the same patient with cen Fluorescein angiogram of the same patient with central retinal vein occlusion in as in previous image, showing leakage from disc, staining of retinal veins.
  • Cotton-wool spots are more common with ischemic CRVO. Usually, they are concentrated around the posterior pole. Cotton-wool spots may resolve in 2-4 months.

  • Neovascularization of the disc: Fine abnormal neovascularization of the disc (NVD) or within 1 disc diameter from the disc may be present. NVD indicates severe ischemia of the retina. NVD is sometimes difficult to differentiate from optociliary shunt vessels. NVD can lead to preretinal or vitreous hemorrhage.

  • Neovascularization elsewhere: Neovascularization elsewhere (NVE) is not as common as NVD. NVE indicates severe ischemia of the retina. NVE can lead to preretinal or vitreous hemorrhage.

  • Optociliary shunt vessels (depicted in the images below) are abnormal blood vessels on the disc, directing blood from retinal circulation to choroidal circulation, which indicate good compensatory circulation.

    Fundus picture of a well-compensated, old central Fundus picture of a well-compensated, old central retinal vein occlusion showing optociliary shunt vessels.
    Red-free photo of the same patient with central re Red-free photo of the same patient with central retinal vein occlusion as in the previous image, showing prominent optociliary shunt vessels.
  • Preretinal or vitreous hemorrhage

  • Macular edema with or without exudates

  • Cystoid macular edema

  • Lamellar or full-thickness macular hole

  • Optic atrophy

  • Pigmentary changes in the macula


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