Description

• An occlusion of the Retinal vein, usually by a thrombus. Retinal vein occlusions are more common than artery occlusions. These typically affect elderly patients in the sixth or seventh decade of life.
• Painless blurring or loss of vision which gets worse over the next few hours or days usually happens in just one eye indicates retinal vein occlusions. Sometimes there is a complete loss of vision almost immediately
• Central retinal vein occlusion can either be non ischaemic or ischaemic
• Branched retinal vein occlusion is more common and is usually asymptomatic unless the macula is involved

Types

Non-ischaemic CRVO

• Most common clinical variety (75%)
• Sub acute, Mild to moderate visual loss
• No Relative afferent pupillary defect (RAPD)
• Early cases -Fundus examination reveals mild venous congestion and tortuosity
• Late stages (after 6–9 months)- there appears sheathing around the main veins

Ischaemic CRVO

• Refers to acute (sudden) complete occlusion of central retinal vein
• Marked sudden visual loss
• RAPD is present
• Early cases -Fundus examination reveals Massive engorgement, congestion and tortuousity of retinal veins, Massive retinal haemorrhages
• Late stages -Marked sheathing around veins and collaterals is seen around the disc, Neovascularization may be seen at the disc (NVD)
• Systemic associations - Hypertension, diabetes mellitus, heart diseases, Dyslipidaemia

Investigation

• Visual acuity
• IOP should be recorded
• Fundus examination with direct and indirect ophthalmoscopy and with 90D slit-lamp examination -Massive retinal haemorrhages
• Goldmann perimetry and ERG
• Fundus Fluorescein Angiography (FFA­)- to differentiate ischaemic from non ischaemic forms
• Optical Coherence Tomography (OCT) – to check macular oedema

Treatments

• Treatment of systemic and ocular associations
• Medical therapy -Intravitreal anti-VEGFs
• Laser therapy

Ayurvedic Treatment

• Control Systemic Diseases

Internal medicines

• Guduchyadi Kashayam
• Chandraprabha vati
• Patoladi Gritha
• Kaisora guggulu
• Virechana - Avipathi Choorna

Procedures

Measures to control bleeding

• Netraseka - Yasti + Darvi Ksheerakashaya
• Seka - Mridweekadi Kashaya , Manjistadi Ksheera Kashaya
• Jaloukavacharana – Forehead and eyelid
• Nasya - Durva Gritha
• Pratimarsa nasya - Durva Gritha
• Anjana - Chandanadi
• Shirodhara/ Siroabyanga - Asanamanjistadi kera
• Tarpana – Jeevaneeya gana Gritha
• Putapaka

Department

Salakya - Netra