Case 3: Hemicentral Retinal Vein Occlusion
A 70-year-old woman reported that she could see only parts of things and that her vision was blurred in her left eye. She described her vision as “a puzzle with pieces missing.” She had no eye pain but did see floaters in her left eye. She also felt she could see an afterimage of light in her left eye even after the room lights were turned off. The light appeared “like a flash lingering for several minutes.”
The patient’s best-corrected visual acuity was 20/50 in the right eye and 20/200 in the left eye. She had some early nuclear sclerotic cataracts. The funduscopic examination of the left eye showed dot, blot, and flameshaped hemorrhages covering the complete inferior half of the retina. The macula was also involved. No cotton-wool spots were visible. Carotid artery auscultation revealed an audible bruit on the left side.
A hemicentral retinal vein occlusion (HCRVO) was diagnosed. In these rare presentations, there is a thrombus in 1 major trunk of the central retinal vein in the optic nerve. The thrombus usually occurs at the level of the lamina cribrosa in the anterior part of the optic disc, where the 2 trunks have not yet joined.
The risk factors for HCRVO are similar to those for central retinal vein occlusion (CRVO). They include diabetes, hypertension, older age, dyslipidemia, and smoking. Ischemia and neovascular glaucoma can develop in patients with HCRVO. They should be monitored as carefully as patients with CRVO.
This patient’s erythrocyte sedimentation rate, blood glucose level, and blood pressure were normal. A carotid duplex ultrasound study and an internal medicine consultation were scheduled for her.