Differential Diagnosis of Central Retinal Vein Obstruction

Ocular Ischemic Syndrome

“…However, none of the publications on the subject has presented any scientifi c evidence that internal carotid artery occlusive disease and venous stasis retinopathy have a cause-and-effect relationship, nor that chronic retinal hypoxia without appreciable visual loss can produce all these retinal vascular changes. In 1983, Kearns [ 66 ] conceded "It was unfortunate that Kearns and Hollenhorst [ 65 ] chose the name 'venous-stasis retinopathy.' It is true that blood fl ow is slowed in the retinal veins, but the primary problem is the low perfusion pressure in the arterioles.…”

“…Keams [ 66 ] pointed out several differentiating ocular characteristics between "the retinopathy of carotid occlusive disease" and CRVO, and, according to him, these were as follows: 1. Optic disc: Kearns claimed that in the retinopathy of carotid artery disease, the disc never develops edema, which is a major feature of vein occlusion along with hemorrhages on the disc.…”

“…3. Type and location of lesions : According to Kearns [ 66 ]: "The hemorrhages, microaneurysms, and capillary dilatation of central retinal vein tend to be generalized. Usually, they are found distributed evenly over the entire retina.…”

“…Thus, the type and location of lesions have no diagnostic importance in labeling a retinopathy as due to carotid artery disease; unfortunately, this criterion has come to be regarded as a diagnostic feature of carotid artery disease. Brown [ 59 ] claimed that macular edema can develop in carotid artery disease; however, a careful review of his paper indicates that his cases were most probably nonischemic CRVO (according to the criteria used by Kearns [ 66 ] and me); macular edema is a common fi nding in nonischemic CRVO. In 5 of 7 eyes in Brown's [ 59 ] study, visual acuity was 20/25-20/30, in one 20/70, and in another 20/200.…”

Retinal Angiology

“…CRA pressure is low in hypotensive retinopathy but may be normal or even elevated in CRVO or diabetic eye disease mimicing hypotensive retinopathy. 55 …”