Retinal Vein and Artery Occlusions Practice Questions and Correct Answers
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Course
Ophthalmology
Institution
Ophthalmology
Most common and 2nd most common retinal vascular disorders Most common = diabetic retinal disease. 2nd most common = retinal vein occlusion.
Age group most affected by RVO and RAO Elderly.
RVO risk factors Older age. Hypertension. Hyperlipidaemia. DM. Smoking. Obesity. Raised intraocular pressure...
Retinal Vein and Artery Occlusions
Practice Questions and Correct Answers
Most common and 2nd most common retinal vascular disorders ✅Most common =
diabetic retinal disease.
2nd most common = retinal vein occlusion.
Age group most affected by RVO and RAO ✅Elderly.
RVO risk factors ✅Older age.
Hypertension.
Hyperlipidaemia.
DM.
Smoking.
Obesity.
Raised intraocular pressure.
Sarcoidosis.
Behcet's disease.
Polyarteritis nodosa.
Wegener's granulomatosis.
Goodpasture's syndrome.
Hyperviscosity states e.g. myeloma.
Thrombophilic disorders.
Chronic kidney disease.
Cushing's syndrome.
Hypothyroidism.
Most common association in women: COCP.
RVO pathophysiology ✅Most commonly due to thrombus formation but can be due to
vein wall disease and external compression.
Occlusion can occur in the central retinal vein (after retinal veins have entered the optic
nerve) or branch retinal vein (before retinal veins have entered optic nerve).
Which type of RVO is most common? ✅Branch retinal vein occlusions (BRVOs) 3x
more common than central retinal vein occlusions (CRVOs).
Investigations for all RVOs ✅All patients:
- BP
- Blood glucose and lipids (if abnormal, TFTs too)
- FBC
- ESR
- Plasma protein electrophoresis
- ECG
, Depending on individual circumstances (e.g. a young patient), other tests may include:
- Thrombophilia screen including antiphospholipid antibodies and lupus anticoagulant.
- CRP, serum ACE, auto-antibodies, CXR, fasting homocysteine levels.
In eye clinic:
- measure IOP
- fluorescein angiography (investigation of choice)
- OCT (measures retina and can detect macular oedema that fluorescein angiography
has missed because of blockage from haemorrhage)
Why is fluorescein angiography so important in investigation of RVO? ✅Evaluates
retinal capillary non-perfusion, neovascularisation and macular oedema.
CRVO categories ✅Non-ischaemic:
- 75%
- milder form
- 10% resolve fully with good visual outcome but most have persistent visual impairment
- 1/3 progress to ischaemic type
Ischaemic:
- severe
- 50% left with neovascular glaucoma and rubeosis iris about 3 months later
- 90% left with painful eye with severe visual impairment due to macular oedema and
ischaemia
CRVO symptoms ✅Frequently presents with sudden unilateral painless loss of vision
or blurred vision, often starting on waking.
Non-ischaemic:
- mild or absent RAPD
- widespread dot-blot and flame haemorrhages throughout the fundus
- some optic disc oedema
Ischaemic:
- severe visual impairment
- marked RAPD
- similar on fundoscopy to non-ischaemic form but disc oedema more severe
- haemorrhages scattered throughout the fundus in typical blood-storm pattern with
cotton wool spots
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