Patient information

Retinal vein occlusion

What is a retinal vein occlusion? occlusions (BRVO) and central retinal
Occlusion (blockage) of a retinal vein vein occlusion (CRVO).
(see figure 1 below) is a common cause
of sudden, painless reduction in vision. 1. Branch retinal vein occlusions
It occurs when a blockage, often due to (BRVO) are due to obstruction of one of
a blood clot, forms in a retinal vein. the four retinal veins (see figure 2
The retina is the thin membrane that below). Each vein drains approximately
lines the inner surface of the back of a quarter of the retina’s blood supply.
your eye. Its function is similar to that of
the film in a camera. Blockage of one of
the veins draining blood out of the eye
causes blood and other fluids to leak
into the retina, causing bruising and
swelling as well as lack of oxygen. This
interferes with the light receptor cells
and reduces vision. Figure 2- branch retinal vein occlusions

2. Central retinal vein occlusion

Central (CRVO) is due to obstruction of the
retinal
vein
main vein formed from the four
branches which drain blood from the
retina (see figure 3 below). In general,
visual loss is more severe if the central
retinal vein is occluded.

Branch
retinal
vein
Figure 1-retinal veins
There are two types of retinal vein
occlusion, branch retinal vein
Figure 3- central retinal vein occlusion

This information can be made available in alternative formats, such as easy read
or large print on request. Please call PALS: 020 7566 2324/ 020 7566 2325 1
What causes retinal vein occlusion?  Certain rare blood disorders:
A blockage occurs in the vein, often These are normally identified by
due to clots forming, causing simple blood tests. In the unlikely
obstruction of blood flow. The exact event that treatment is required,
reason for this happening is unknown, this will be supervised by a
but several common conditions make specialist in blood disorders.
retinal vein occlusion more likely. These
include: Preventing a return of retinal vein
 High blood pressure: If your occlusion
blood pressure is consistently It is essential to identify and treat any
higher than your GP thinks it risk factors such as the ones above, to
should be, treatment is normally minimise the risk to the other eye and
advised. prevent a further vein occlusion in the
 High cholesterol: Treatment with affected eye. Treatment of any risk
tablets is normally highly factors dramatically reduces the risk of
effective. a further vein occlusion occurring in
either eye. Without treatment, there is a
 Glaucoma: With this common high risk of retinal vein occlusion
eye condition, the pressure in the returning. This can cause further
eye is raised. This can cause damage to the sight of the affected eye
gradual loss of side vision. It also as well as damage to the sight of the
increases the risk of retinal vein other eye. In a small number of cases,
occlusion. Treatment with drops no risk factors can be found, with the
to reduce the pressure is normally cause being unknown.
highly effective in preserving sight
and preventing further retinal vein
occlusions. Effects of retinal vein occlusion and
treatment options
 Diabetes: Retinal vein occlusions
are more common in people with One in three patients with central retinal
diabetes. Detection and treatment vein occlusion may experience
of diabetes is highly effective in worsening of vision in the first three
preserving vision and preventing years.
further retinal vein occlusions. In retinal vein occlusion, vision is
 Smoking: The more you smoke, reduced secondary to:
the greater the risk of another 1) Damage to the retina caused by the
vein occlusion. Please speak to obstruction to blood flow in the veins.
your GP if you need help to stop There is no treatment for this.
smoking. You can also call the 2) Collection of fluid in the retina
Smokefree National Helpline for (macular oedema). There are several
advice on 0800 022 4332 or visit successful treatment options for this,
https://www.nhs.uk/smokefree. which are described below.

Moorfields Eye Hospital NHS Foundation Trust

City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk 2
 All injection treatments have potential
Treating fluid in the retina (macular side effects, including a 1 in 1500
oedema) chance of infection, causing decreased
Persistent bruising and swelling at the vision.
centre of the retina (the macula) is the Anti-VEGF injections are also
main cause of permanent loss of associated with increased risk of
central vision. The swelling is caused cardiovascular side effects. Steroid
by damaged blood vessels which leak injections may cause side effects such
fluid. as the formation of a cataract. They
Different medicines such as anti- also may cause raised eye pressure,
vascular endothelial growth factor (anti- which can result in glaucoma.
VEGF) medicines or steroids may be
helpful in reducing this leakage. The above options for treating macular
oedema have both advantages and
Anti-VEGF medicines are given as a disadvantages, which may be more or
fluid injection and need to be given less suitable for each person with
every month until maximum vision is retinal vein occlusion. Your
achieved. After that, they may be given ophthalmologist can discuss this in
on extended intervals, depending on more detail with you. More information
whether they are necessary, until there on each treatment is available in our
are no signs of active disease. Anti-VEGF intravitreal injection
Treatment is needed for up to four treatment leaflet.
years on average.
If you would prefer not to have active
Steroids are given in the form of an treatment for macular oedema,
implant injected into the eye which can observation or monitoring the
be repeated every four to six months as condition of your eye is always an
needed, for an average of four years. option. Branch retinal vein occlusions
have a better chance of the fluid
Injection treatment aims to stabilise or naturally clearing up than central retinal
improve vision. About 50% of patients vein occlusions. However, early active
treated with anti-VEGF injections injection treatment of macular oedema
experience a significant gain in vision (a has been shown to achieve the best
three line improvement on a standard results in terms of vision improvement.
vision chart). Steroid implants achieve a Again, your ophthalmologist can
significant gain in vision in up to 50% of discuss this in more detail with you.
patients. However, 20-30% of patients
experience no improvement in vision Treating abnormal new blood vessel
following injection treatment, be it an growth (neovascularisation)
anti-VEGF or steroid injection. About 20% of patients with retinal vein
occlusions develop abnormal blood

Moorfields Eye Hospital NHS Foundation Trust

City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk 3
vessels on either the iris at the front of a series of retinal photographs taken
the eye or on the retinal surface. These over several minutes. This test gives
abnormal blood vessels can bleed or your doctor more information about
cause a marked pressure rise in the the condition of your retina, which
eye, leading to further loss of vision and will help decide which treatment is
pain in some cases. most appropriate for you.
 Optical coherence tomography
This can normally be prevented by a (OCT) measures the amount of
specific type of laser treatment to the retinal swelling (macular oedema)
retina (called Pan Retinal which, like fluorescein angiography,
Photocoagulation or PRP laser). It is helps decide which treatment is most
important to note that this treatment is appropriate for you. OCT is also
aimed at stabilizing and preserving the used to monitor your retina over time
condition of the eye and so will not and can show how effective any
improve vision. The treatment is most treatment may have been. It is
effective if done before vision is lost effectively ‘optical ultrasound’, a non-
due to new blood vessel growth. For invasive test, using reflections from
this reason, patients with central retinal within your retina to provide a cross-
vein occlusions are normally reviewed sectional picture of the retina.
every four to six weeks for six months.
In the case of an emergency
Follow-up after treatment If your eye suddenly becomes red,
If injection treatment is given, you will painful or your vision worsens, go to
need to attend appointments for Moorfields A&E department in City
injections or monitoring every four to Road (open 24/7 for emergency eye
eight weeks for the first year and then problems only).
less frequently in the next three years.
Further information
Additional tests available for retinal You may find the following websites
vein occlusion helpful.
The following procedures are frequently www.rcophth.ac.uk
recommended for patients with retinal
vein occlusion. Your doctor will explain www.rnib.org.uk
the reasons for them in more detail with www.iga.org.uk
you in person.
Authors: Peter Addison and Luke Nicholson
 Fluorescein angiography is a Revision number: 5
Approval date: September 2018
diagnostic test which involves the Review date: September 2021
injection of fluorescein (yellow) dye
into your bloodstream via a vein in
your hand or arm. This is followed by

Moorfields Eye Hospital NHS Foundation Trust

City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk 4
Moorfields Eye Hospital NHS
Foundation Trust
City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk

Moorfields Direct telephone helpline

Phone: 020 7566 2345
Monday-Friday, 8.30am-9pm
Saturday, 9am-5pm
Information and advice on eye
conditions and treatments from
experienced ophthalmic-trained nurses.

Patient advice and liaison service

(PALS)
Phone: 020 7566 2324/ 020 7566 2325
Email: [email protected]
Moorfields’ PALS team provides
confidential advice and support to help
you with any concerns you may have
about the care we provide, guiding you
through the different services available
at Moorfields. The PALS team can also
advise you on how to make a complaint.

Your right to treatment within 18

weeks
Under the NHS constitution, all patients
have the right to begin consultant-led
treatment within 18 weeks of being
referred by their GP. Moorfields is
committed to fulfilling this right, but if
you feel that we have failed to do so,
please contact our patient advice and
liaison service (PALS) who will be able
to advise you further (see above). For
more information about your rights
under the NHS constitution, visit
www.nhs.uk/choiceinthenhs

Moorfields Eye Hospital NHS Foundation Trust

City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk 5