Case 2: Branch Retinal Vein Occlusion
A 76-year-old man presented for an annual eye examination; his only complaint was that he had some difficulty in reading fine print. He was pseudophakic in both eyes. He had hypertension, hyperlipidemia, type 2 diabetes mellitus, and moderate obesity.
His best-corrected visual acuity was 20/20 in each eye. Intraocular pressures were normal. There was no afferent pupillary defect. The funduscopic examination of the right eye identified dot and blot intraretinal hemorrhages extending from the optic disc into the supranasal quadrant (A). A red-free photograph helps show the extent of the hemorrhages by increasing fundus contrast (B). No diabetic retinopathy was noted.
Branch retinal vein occlusions (BRVOs) result from localized thrombosis inside a single retinal vein. BRVOs occur at sites of arteriovenous crossing, where the artery and vein share a common adventitial sheath. The artery causes compression or deformation of the vein, which leads to the formation of thrombi. BRVOs that do not affect the macula can be asymptomatic, as in this patient.
The management of a BRVO is the same as that of a central retinal vein occlusion. This patient was referred back to his internist. The patient is being monitored monthly with dilated eye examinations to identify any ischemic neovascular development.