Branch retinal vein occlusion

DESCRIPTION, SYMPTOMS, SIGNS, PREVALENCE, SIGNIFICANCE, DIFFERENTIAL DIAGNOSIS

See Branch retinal vein occlusion - Assessment.

MANAGEMENT

Urgent
Initial management relates to any underlying systemic disease or possible glaucoma. Treatment may help to reduce the risk of stroke (cerebrovascular accident) or an additional subsequent ocular vascular occlusion.

Blood tests
Patients need a full blood workup to treat any underlying systemic risk factors such as hypertension, diabetes, carotid stenosis or cardiovascular disease.

Oral medication
Review antihypertensive and other medications, and consider daily aspirin. Discontinuation of oral contraceptives might be considered.

Ocular tests
Risk factors for glaucoma should be evaluated, and intraocular pressure reduced if necessary. Assess for neovascularisation of the disc or elsewhere on the retina. Neovascularisation of the iris, anterior angle or neovascular glaucoma are rarer complications.

Fluorescein angiography may be indicated to assess retinal capillary non-perfusion; the presence of an area of more than five disc diameters is a risk for development of neovascularisation. Usually a fluorescein angiography is indicated 2-3 months after a BRVO, once the haemorrhages have cleared.

Laser treatment
In many patients with BRVO, no laser treatment may be necessary. However, recognised indications are macular oedema or neovascularisation. Grid argon laser treatment for macular oedema is indicated in the presence of: