Central Retinal Vein Occlusion

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The retina is the thin film that lines the back of the eye, similar to the film of a camera. It is the part of the eye that makes us see. Light (things that you see) enters in through the front of the eye and falls on the retina. The retina turns the light into electrical signals that are sent to the brain, allowing you to see. The veins drain the blood out of the eye, whilst the retinal arteries are the small pipes that deliver the blood (from the heart) to the retina, shown in red in these diagrams. These arteries deliver the blood to the whole of the retina.
cut through diagram of eye, showing arteries and veins the veins of the retina may block:
this is a side ‘cut through’ diagram of an eye


What is a retinal vein occlusion?

A retinal vein occlusion is a blockage of one of these veins. The vein blocks when blood in it stops flowing; then the vein cannot drain the blood out of the retina. When the vein blocks some blood leaks out. In addition, clear fluid leaks out causing ‘water-logging’ the retina. This naturally damages the sight.


Where does the vein block?

It is that blood flowing through the vein may be blocked by something pressing on the vein. For example, any condition, such as high blood pressure for many years, that makes the small arteries ‘hard’, may cause the artery to press on the vein and block it. In a branch retinal vein blockage, the blockage is along the course of a retinal vein:

In a central retinal vein occlusion, the blockage is at the optic nerve:
central retinal vein occlusion, flow obstructed at optic nerve central retinal vein occlusion, flow obstructed at optic nerve


When is your sight affected?

The centre of the retina is responsible for your sharp vision, such as seeing people’s faces or watching television. If this central part of the retina (a tiny yellow spot in these diagrams) becomes ‘waterlogged’ by leakage from the blocked vein, your sight will be reduced. After approximately 3 months, if the waterlogging remains, laser treatment may help to seal any leaks. retina, what the doctor sees, fovea


Factors that contribute to retinal vein occlusion

High blood pressure Controlling the blood pressure helps to prevent the arteries getting ‘harder’, and can prevent a blocked vein in the other eye. Some experts now believe a blood pressure below 140/80 will not only help prevent a second occlusion, but help reduce any retinal leakage from the one present already.
High blood pressure triples the risk of a retinal vein occlusion, see For information about blood pressure, visit
high BP causes treatment

Too much fat in the blood A healthy diet helps. The Department of Health (& World Health Organisation) recommends people can help themselves by having a balanced diet including:

  • five portions of vegetables or fruit every day
    …this is likely to reduce a recurrence by about 20%, see
  • eating small amounts only of animal fat (meat, dairy food)
  • salt: too much may contribute to blood pressure
  • 2 portions of fish such as salmon or tuna a week
  • 30 minutes exercise a day (eg walking, swimming)

Some experts recommend that many patients should use ‘statin’ tablets to lower their cholesterol, as this will also prevent heart and other diseases. (However, fibrates are preferable if the fasting triglyceride level is high.) Obesity quadruples the risk of a retinal vein occlusion, see.

Smoking This hardens all the arteries. The more you smoke, the more damage is done. Try to stop: ask your GP or nurse if you need help. See Smoking also contributes to cataracts, causing 25% of cataracts in the UK overall, and also 30% of macular degeneration. Smoking triples the risk of a retinal artery occlusion and carotid artery narrowing (and carotid artery narrowing is much more common in retinal vein occlusion patients, see)

Glaucoma, diabetes, and other conditions Other conditions may also cause a blockage of a retinal vein (retinal vein occlusion, RVO), and extra treatment may be needed. Your doctor will check that you do not have one of these conditions. Sometimes the cause is not found. Patients with glaucoma who develop an RVO need to have a lower eye pressure. Patients with intraocular hypertension need to be treated as though they have early glaucoma, and need a low pressure.
Oral contraceptive pills should be stopped.
If you are using hormone replacement therapy and have a retinal vein occlusion, some experts advise generally this should be stopped. High fibrinogen levels in the blood contribute to retinal vein occlusions, and these may be increased by stress or unhappiness, see If you are young or have had other venous occlusions, a check for other conditions may be needed. These include antiphospholipid antibody syndrome, factor V Leiden, or less commonly factor 5 or S abnormalities. For medical details see. Younger patients may need systemic steroids. If an RVO occurs in a patient with diabetic retinopathy, the outcome will be much worse…much more leakage, and new vessel development is much more likely. Sleep apnoea increase the risk. Patients with sleep apnoea need treatment and need to lose weight Archives 2010


Types of retinal vein occlusion

A small ‘branch’ retinal vein occlusion If the central area of retina, the macula (shown in yellow) is not affected, the vision may be completely normal. The red marks show the ‘haemorrhages’ in the retina.


A more severe ‘branch’ retinal vein occlusion Inevitably the central part of the retina is affected, reducing your sight, and laser is often needed. Laser treatment may be needed to reduce waterlogging, stabilising the sight. Hemispherical RVO review Retina 11 See photo (from and photo and larger and RVO case with large photos


A central retinal vein occlusionUnfortunately, your sight is usually affected in this type of blockage. (Although a very mild blockage may not affect your sight.) Laser treatment does not improve the sight, but it may be necessary to prevent complications: tiny blood vessels can grow where they should not, leading to bleeding later. For medical details see. If the blockage is severe, a lot of laser is needed to prevent severe glaucoma (animation here). See photo (


A retinal artery macroaneurysm

This occurs when one of the tiny retinal arterioles at the back of the eye block. A widened segment appears at the site of the blockage, and this may start to leak.
This is not really a retinal vein occlusion, but the causes are similar (hardening or the retinal arterioles), and it sometimes looks similar.
Here is a photo and another in 2002 & 7 and close up. Subthreshold laser may help BJO 2011


What is laser?

‘Laser’ is a very bright, but very narrow, beam of light. You need to sit in a machine like the one used to examine your eye, and the light is shone in through a small contact lens.
If your condition is mild, the laser treatment does not usually hurt. (see Laser 2005) 2011 laser leaflet LASER is simply a highly focused and powerful light, where the light rays are all of the same type. For this reason it can be pointed at one spot very accurately.

Laser light (yellow) is shone into the eye through a small contact lens, and makes small burns on the retina.


Risk of rubeotic glaucoma / posterior segment neovascularisation/vitreous haemorrhage

Risk of rubeotic glaucoma (Score 11)

  • 8.5% CRVO
  • 2.4% BRVO

Risk of posterior segment neovascularisation/vitreous haemorrhage (new vessel growth /blleding)

  • 9% CRVO
  • 8% BRVO

Risks are considerably reduced with laser.



What can you do?

  • A healthy diet and regular exercise can help. Lots of vegetables and fruit (five 100gm portions a day), and fibre may help, with the minimum of animal fat, dairy food, and salt. Exercise, such as walking or swimming, 30 minutes a day minimum is also recommended (Department of Health).
  • Aspirin may help to prevent further blockages, and it also helps to prevent heart disease. Ask your GP. There are alternatives to aspirin if you have a peptic ulcer or indigestion (clopidrogel). Your GP will need to advise if you have very high blood pressure.

Disclaimer: These Wellness Protocols are not intended to replace the attention or advice of a physician or other qualified healthcare professional. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

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