Retinal hemorrhages – ?

CC: Reduced vision in left of unknown onset or duration

HPI – A 64 year old male presented for a routine eye examination. He had noticed a slight dreduction of vision in his LE; but  had attribtuted this to a lifelong diagnosis of “amblyopia”. The Best vision in 2008 in the left eye was as 6/7.5-

PMH – The medical history was vague with no recent medical evaluation of 10 years. There is a history of diabetes.

Unaided R) 6/6 L 6/18

PE: LE small hypermetropic Rx with BCVA of 6/12’ IOPs R) 22 L) 23.5mmHg with NCT

ASSESSMENT: Probable branch retinal vein occlusion (BRVO)

PLAN: Referral to primary care medical provider for further vascular work up

QUESTIONS: What else do you think this might be? How would you manage this patient if this walked into your office/

Frome e-medicine

  1. The potential etiology is hypertension, inflammation or other thrombotic enve.
  2. 2/3 of the occurrences are in the supratemporal quadrant (this quadrant has the most a/v crossings).
  3. The main pathology is arterial compression onto the vein.
  4. In the US the Beaver Dam Study reports a prevalence of 0.6% in patients older than 43 years old.  It is similar over racial groups.  Internationally, the Blue Mountain Study shows that the prevalence is 1.1% for those over 48 years of age.
  5. A 9-year follow up study in the UK shows a relationship between cardiovascular mortality and all kinds of retinal vein occlusion.

My compliments to Akil Kanani for the case details and the image. To return to my Fan Page, click here.

About Richard Hom OD, MPA

Dr. Hom holds Doctor of Optometry and Masters in Public Administration degrees and practices family eye care and consults on public policy, health information technology and program evaluation.
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