Retinal Vein Occlusion (RVO) Treatment & Management

Updated: May 18, 2017
  • Author: Jesse Borke, MD, FACEP, FAAEM; Chief Editor: Gregory Sugalski, MD  more...
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Treatment

Prehospital Care

There is no specific prehospital treatment for retinal vein occlusion (RVO).

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Emergency Department Care

The primary directive in the ED is to make the diagnosis clinically and arrange urgent consultation with the ophthalmologist. As there is no specific ED treatment for RVO, it does not represent a true “lights and sirens” emergency. However, because of the potential for permanent vision loss, no patient should leave the ED without a sound and specific plan for urgent ophthalmological evaluation. Same-day or next-day evaluation in the office or ED is appropriate.

Of note, a systematic review of multiple small randomized trials of antithrombotic and thrombolytic medications, including aspirin, clopidogrel (Plavix), heparin, and tPA, found limited or no benefit in RVO, owing mostly to lack of available evidence. [41] Currently, there is not enough evidence to recommend the routine use of antithrombotics in RVO, except in the case of a predisposing coagulopathy.

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Consultations

Consultation with an ophthalmologist is necessary. All patients require a sound and specific plan for urgent ophthalmological evaluation prior to discharge. Same-day or next-day evaluation is appropriate.

The ophthalmologist’s treatment of RVO is aimed at maintaining visual acuity by monitoring the patient for and treating complications such as macular edema and neovascularization. In 2008, TheCanadian Journal of Ophthalmology noted, "No intervention has emerged as the standard of care. Current management in most centers is close observation for complications and treatment as they arise." [6]

Macular edema in patients with RVO may be treated with intravitreal anti-VEGF (first line) and/or intravitreal steroids, while neovascularization in patients with RVO (especially branched retinal vein occlusion [BRVO]) may be treated with laser photocoagulation. In refractory cases, vitrectomy may be required.

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Medical Care

The primary physician’s treatment of RVO is aimed at managing predisposing risk factors. Hypertension, diabetes mellitus, atherosclerosis, and glaucoma are major risk factors in older patients. Hypercoagulability and vasculitis are key risk factors in the development of RVO in younger patients.

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