Synopsis
Recognise the distribution of a retinal venous occlusion, separate macular leakage from ischaemic risk and organise treatment and surveillance without prescribing unsupported systemic anticoagulation.
- Central retinal vein occlusion usually causes widespread venous dilatation and haemorrhage; branch occlusion follows the territory of an affected venous branch.
- Macular oedema is a major reversible contributor to reduced acuity, whereas macular ischaemia can limit recovery despite a drier retina.
- OCT assesses macular fluid; angiographic assessment and clinical findings establish the extent of non-perfusion.
Key red flags
New iris vessels, pain, redness or nausea after an ischaemic retinal vein occlusion requires urgent assessment for neovascular glaucoma.
Investigation priorities
Classify the distribution and assess functional loss, pressure and anterior-segment risk.
Management branches
New painless monocular visual loss has a venous haemorrhagic pattern.
- Refer directly through an urgent eye pathway, with same-day escalation if the diagnosis is uncertain or pain, severe pressure elevation or an arterial pattern is present.
- Record corrected acuity and obtain retinal examination, OCT and perfusion assessment as required to define oedema and ischaemia.
Key medicines
Ranibizumab for RVO-related macular oedemaLucentis is administered intravitreally at 0.5 mg, equivalent to 0.05 mL, per treated adult eye. Start with one dose monthly until stable maximum vision and/or inactivity; initially at least three monthly treatments may be required. Doses to the same eye must be separated by at least four weeks. The retinal clinician then adjusts the interval and discontinues treatment when meaningful benefit is absent.
Dexamethasone, Ozurdex intravitreal implantAdminister one 700-microgram implant intravitreally into the affected adult eye. In RVO, consider another implant only after an initial response followed by loss of benefit when the likely gain outweighs risk; information on intervals shorter than six months is limited. Do not repeat while improvement persists or when deterioration was not slowed by treatment.