Retinal vein occlusion (retinal vein thrombosis): symptoms, diagnosis and treatment
Retinal vein occlusion usually develops very quickly. A person notices a fog, a spot in front of the eye, or a significant deterioration in vision on one side. The cause is a disruption of venous outflow in the fundus, when a vessel becomes blocked by a blood clot. In this condition, the retina quickly suffers from swelling and hemorrhages. Therefore, delaying an examination is dangerous.
During the appointment, the doctor determines the affected area, assesses the risk of complications, and explains the diagnosis, monitoring, and treatment procedures for retinal vein thrombosis.
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Why does retinal vein thrombosis occur?
Retinal vein thrombosis is almost always caused by vascular and blood problems. Less frequently, local eye conditions play a role. Most often, there are multiple causes, and it's important to understand each one.
Vascular risk factors
The leading causes are hypertension, atherosclerosis, diabetes, and increased blood viscosity. These damage the vessel walls and slow blood flow, making it easier for a clot to form. Therefore, a patient with this diagnosis requires a comprehensive examination, not just the eye itself.
Smoking, obesity, and a sedentary lifestyle also play a role. These factors increase the strain on the vessels of the fundus. Controlling blood pressure and sugar levels significantly reduces the risk.
Ophthalmic causes
Sometimes the eye itself plays a role. Increased intraocular pressure in glaucoma impairs blood flow. Less commonly, inflammatory processes and structural issues with the retinal vessels are the cause.
Who is at high risk?
The risk is highest in older people with hypertension and diabetes. A hereditary predisposition to thrombosis is also a factor. It is especially important for these patients to have their fundus examined regularly by an ophthalmologist.
Bleeding disorders and the use of certain medications increase the risk. If one eye has already suffered an occlusion, the other eye is also monitored. This helps detect the problem early.
Symptoms that require urgent consultation with an ophthalmologist
The main symptom is a rapid and painless decrease in vision. There is usually no pain, and this is the insidious nature of this condition. Let's look at what to look for so as not to waste time.
Sudden decreased vision
Sudden deterioration of vision in one eye is the most common symptom of thrombosis. It can develop within minutes or hours, usually in the morning after waking up. Because there is no pain, people sometimes postpone a visit, which is a mistake.
Fog, spots, distorted vision
A fog or veil appears in front of the eye, and straight lines become distorted. Sometimes part of the visual field is lost, or a dark spot appears in the center. These symptoms indicate swelling and hemorrhages in the fundus.
Hemorrhages, flashes, and complications
During the examination, the doctor sees multiple hemorrhages and dilated veins in the retina. Flashes and floaters are also present, which is a warning sign. These symptoms indicate a risk of complications and require urgent evaluation.
You should make an appointment with an ophthalmologist as soon as possible if the following symptoms occur:
- Sudden deterioration in vision
- Appearance of fog or "curtain"
- Distortion of lines and objects
- Multiple dark spots
- Flashes, hemorrhages, or severe discomfort
Even if your eye doesn't hurt, don't delay: with a vascular problem, time directly affects the outcome.
How we diagnose retinal vein occlusion
Diagnosis of retinal vein occlusion begins with an examination and takes one visit. Our goal is to confirm the diagnosis, assess the severity, and find the cause. This determines the treatment and monitoring plan.
Ophthalmologist examination and fundus examination
First, the doctor checks visual acuity and examines the fundus with the pupil dilated. Even at this stage, the following are visible:
- Dilated veins
- Hemorrhages and swelling
The fundus examination allows one to suspect the type and extent of the process.
OCT and assessment of macular edema
To measure central retinal swelling, OCT (optical coherence tomography) is performed. This method shows the thickness of the retina layer by layer and accurately records macular edema. It is also used to monitor how the tissue responds to treatment.
Fluorescein angiography and additional methods
If necessary, fluorescein angiography—a blood flow study using contrast—is prescribed. It shows areas where the retinal vessels have become blocked and identifies ischemia. These data help determine the treatment strategy and whether laser treatment is necessary.
Checking for associated risk factors
Since the cause is often general, we evaluate blood pressure, sugar levels, and vascular health. If necessary, we refer the patient to a primary care physician or cardiologist. Without monitoring these factors, eye treatment will be incomplete.
| Method | What it's for | What it helps identify |
|---|---|---|
| Fundus examination | Initial assessment of the retina | Hemorrhages, varicose veins |
| OCT | Assessment of retinal structure | Macular edema, layer changes |
| Fluorescein angiography | Blood flow assessment | Ischemia, vascular obstructions |
| Anti-VEGF therapy | Treatment as indicated | Reduction of swelling, improvement of visual function |
General information
Retinal vein occlusion treatment
Treatment for retinal vein occlusion is tailored to the individual patient, depending on the severity and type of the condition. There is no universal treatment plan, and the outdated idea of "dissolving the clot with eye drops" is ineffective. The goal is to reduce swelling, maintain vision, and reduce the risk of complications.
Observation and progress monitoring
In mild cases, the doctor opts for observation with regular OCT monitoring. This allows for early detection of swelling and appropriate intervention. At the same time, general risk factors are corrected.
Anti-VEGF injection therapy
The primary treatment for macular edema is intraocular injections of anti-VEGF medications. They:
- Reduce swelling
- Help improve
- Stabilize vision
The doctor determines the course and number of injections based on the OCT results.
Laser coagulation when indicated
If there are areas of ischemia and a risk of neovascularization, retinal laser coagulation is used. The laser treats bloodless areas and reduces the risk of dangerous complications. This method is used selectively, as indicated.
Correction of concomitant diseases
Eye treatment will be incomplete without addressing the underlying cause. Therefore, we help establish control over blood pressure, sugar, and other factors in collaboration with specialized doctors. This reduces the risk of recurrence in the same or second eye.
In my experience, with retinal vein occlusion, it's not just the treatment itself that matters, but also the speed of diagnosis: the sooner we perform an examination, OCT, and assess the type of occlusion, the more accurately we choose the treatment plan and the higher the chance of preserving vision. With us, patients receive a clear action plan already at the first appointment. – ophthalmologist
FAQ
Short answers to the questions most frequently asked during appointments.
What are the dangers of retinal vein occlusion?
Is it possible to restore vision after retinal vein thrombosis?
What tests are needed to confirm the diagnosis?
What should you do immediately after symptoms appear?
Retinal vein occlusion is a reason to act quickly, even if the eye is not painful. The sooner diagnosis and treatment are started, the greater the chance of preserving vision.
When you shouldn't delay a consultation
If vision in one eye has suddenly deteriorated, or if fog, spots, or distorted lines appear, schedule an appointment as soon as possible. Vascular medications alone won't solve the problem. Delaying treatment increases the risk of permanent changes.
How we help patients from the first visit
At the very first appointment, we conduct an examination, OCT, and assess the type of occlusion. The patient receives a clear treatment and monitoring plan, and, if necessary, referrals to related specialists. We then provide ongoing management until their condition stabilizes.
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How does retinal vein occlusion develop?
The retina lines the inside of the eye, captures light signals, and is involved in transmitting visual information to the brain. It is fed by small vessels, and blood flows through the veins. When a vein becomes blocked by a thrombus, outflow is disrupted, tissue pressure increases, and hemorrhages and swelling occur. This quickly deteriorates vision.
Essentially, this is a vascular catastrophe in the fundus, similar in mechanism to thrombosis in other organs. Therefore, general vascular diseases are almost always involved. Let's look at the different forms of this condition and why it is so dangerous.
What is the difference between central retinal vein occlusion and branch retinal vein occlusion?
If the main trunk is blocked, central retinal vein occlusion develops, affecting almost the entire fundus. If a thrombus blocks only one branch, it's called a branch occlusion: only part of the visual field is affected. Central retinal vein thrombosis is usually more severe and causes greater vision loss.
The prognosis and treatment plan depend on which vessel is affected. With branch retinal vein occlusion, some vision can often be preserved. The exact shape is determined by a doctor during a fundus examination.
Why is this condition dangerous for vision?
The main threat is persistent vision loss due to swelling of the central retina. This swelling is called macular edema, and it is what most often impairs visual acuity. If blood flow is impaired for a long time, ischemia—a lack of oxygen in the tissues—develops.
In response to ischemia, the eye begins to grow defective vessels, resulting in neovascularization. These vessels are fragile, prone to new hemorrhages, and can increase intraocular pressure. Therefore, without observation, the condition can progress.