The central retinal vein exits the optic nerve and drains into the superior ophthalmic vein. It collects venous outflow from the four quadrants of the retina through the superior and inferior retinal veins. Intraocular pressure is transmitted to the venous outflow from the eye; elevated IOP compresses the central retinal vein where it crosses the lamina cribrosa within the optic nerve.
Central retinal vein occlusion (CRVO) is characterised by flame-shaped haemorrhages in all four retinal quadrants, disc oedema, and dilated tortuous veins on fundoscopy — the thunder-storm fundus appearance. Risk factors include hypertension, glaucoma, hyperviscosity syndromes, and thrombophilia. Visual loss from macular oedema is the main complication, treated with intravitreal anti-VEGF injections. Non-ischaemic CRVO has a better prognosis than ischaemic CRVO, where neovascularisation and neovascular glaucoma may develop.
Thrombotic occlusion of the central retinal vein produces the thunder-storm fundus with widespread flame haemorrhages in all quadrants, disc oedema, and dilated veins, causing variable visual loss from macular oedema managed by intravitreal anti-VEGF injections, with risk of neovascular glaucoma in ischaemic cases.
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