Intended for healthcare professionals

Clinical Review

Managing retinal vein occlusion

BMJ 2012; 344 doi: (Published 22 February 2012) Cite this as: BMJ 2012;344:e499

This article has a correction. Please see:

  1. Christine A Kiire, clinical research fellow and ophthalmic specialty trainee,
  2. N Victor Chong, consultant ophthalmic surgeon
  1. 1Oxford Eye Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK
  1. Correspondence to: V Chong victor.chong{at}
  • Accepted 10 January 2012

Summary points

  • Retinal vein occlusion is the second most common retinal vascular disease after diabetic retinopathy

  • Occlusion can occur in the central retinal vein or, more commonly, in a branch retinal vein

  • The main risk factors for retinal vein occlusion are age over 50 and hypertension

  • Signs of retinal ischaemia include poor visual acuity, relative afferent pupillary defect, multiple intraretinal haemorrhages, multiple cotton wool spots, and dilated and tortuous retinal veins

  • Management of underlying medical conditions and cardiovascular risk factors is important

  • Ophthalmic treatments now include intraocular dexamethasone implants and, potentially, vascular endothelial growth factor inhibitors

Retinal vein occlusion—obstruction of the retinal venous system by thrombus formation, external compression, or disease of the vein wall1—is the second most common retinal vascular disease after diabetic retinopathy.2 Pooled data from population studies in the United States, Europe, Asia, and Australia suggest that about 16 million adults are affected by this condition.3 Not all cases need treatment. In the past, the visual prognosis for most patients was poor because treatment comprised lowering the pressure in the eye, if raised, and laser treatment to try to control associated complications. However, two new treatments have recently been licensed in the US and the European Union, one of which has been approved by the National Institute for Health and Clinical Excellence (NICE) for use in England and Wales. Consequently, the outlook for patients with retinal vein occlusion is likely to improve. We review the diagnosis and management of retinal vein occlusion and examine the evidence for the effectiveness of the newly licensed drugs.

Sources and selection criteria

We searched PubMed for articles on retinal vein occlusion that had been published in 2010 and 2011 and looked for published evidence that had been presented in major ophthalmology meetings up to 1 October 2011, focusing mainly on well designed randomised …

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