Retinal Vascular Occlusions

Retinal vascular occlusions develop when blood flow is blocked in the veins (retinal vein occlusion) or arteries (retinal artery occlusion) that supply the retina; they have two main types — the more common retinal vein occlusion (RVO) and the rarer but more dangerous retinal artery occlusion (RAO) — and can lead to sudden, painless vision loss.

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Ophthalmology · Istanbul

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Retina Retina · Cataract Treatment

Ankara Univ. Medical School

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Quick Answer

A retinal vascular occlusion occurs when blood flow in the retinal vessels is suddenly blocked; its effect on vision depends on the type and location of the occlusion and how early treatment is started, and because it often causes sudden, painless vision loss it requires urgent evaluation.

Frequently Asked Questions

Main Types of Retinal Vascular Occlusion

1. Retinal Vein Occlusion (RVO):

It is the most common vascular occlusion.
An occlusion in a retinal vein blocks blood flow, and haemorrhages and oedema develop.
It is classified as central (CRVO) or branch (BRVO).

2. Retinal Artery Occlusion (RAO):

It is rarer but more dangerous.
Blood flow is cut off due to a clot or embolus in the eye’s artery.
It can result in sudden, severe and usually irreversible vision loss.

What Causes It?

Retinal vascular occlusions usually develop in association with the following risk factors:

Hypertension (high blood pressure)
Diabetes
High cholesterol
Heart disease
Use of blood thinners or clotting disorders
Smoking
Glaucoma (high eye pressure)

What Are the Symptoms?

Symptoms may vary according to the type and severity of the occlusion:

Sudden, painless vision loss
Blurring or darkening at the centre of vision
Shadows in the visual field
Distorted or broken vision
Fading of colours (particularly in arterial occlusions)
Rarely, flashes of light in the eye

How Is It Diagnosed?

The ophthalmologist makes the diagnosis with a detailed retinal examination and imaging tests. The main methods used are:

OCT (optical coherence tomography): retinal oedema and structural changes are observed.
FFA (fundus fluorescein angiography): the location of the occlusion and areas of haemorrhage/leakage are identified.
ICG and ultrasonography: in special cases, vascular structures are assessed in detail.

Treatment Methods

Treatment is planned according to the type of occlusion and the complications it causes.

Intravitreal Injections (Anti-VEGF and steroids):

These are used to reduce oedema and protect vision. Treatment usually continues at intervals of a few months.

Laser Photocoagulation:

This is used to prevent the growth of new vessels or to stop bleeding.

Systemic Treatment and Referral:

Patients are often referred to cardiology, internal medicine or haematology. Treatment is directed at the underlying cause.

Emergency Intervention (in arterial occlusion):

When an arterial occlusion occurs, vision can rarely be saved within the first few hours with hyperbaric oxygen therapy, ocular massage or intraocular paracentesis.

Is There a Risk of Permanent Vision Loss?

Yes. The risk of permanent vision loss is high, particularly if the macula (the centre of vision) is affected and treatment is delayed. For this reason, patients experiencing sudden changes in vision should see a retina specialist without delay.

How Can It Be Prevented?

Regular monitoring of blood pressure, blood sugar and cholesterol levels
Stopping smoking
Control of cardiovascular disease
Regular eye check-ups (particularly in at-risk groups)
Investigation of clotting disorders (referral to haematology if necessary)

Frequently Asked Questions

I have had a retinal vascular occlusion — can I fully recover?

Your level of vision depends on the type and location of the occlusion and how early treatment is started. Particularly if the macula has not been affected and treatment is begun early, vision may recover to a significant degree. However, permanent loss is more common in arterial occlusions.

Can a retinal occlusion recur?

Yes. Especially if there is an underlying systemic condition (for example high blood pressure, diabetes, or blood clotting disorders), a retinal occlusion can recur. A thorough systemic evaluation and follow-up are therefore very important.

My blood pressure is high but I have no eye complaints. Am I still at risk?

Yes. High blood pressure is an important risk factor for retinal vascular occlusions. Even in the absence of any complaints, an annual retinal examination is very important for detecting early signs.

Is a retinal vascular occlusion painful?

No. It usually presents with sudden, painless vision loss. This painlessness may make the condition seem mild, but it is an emergency. Anyone experiencing vision loss should see an ophthalmologist as soon as possible.

Do intravitreal injections hurt?

No. Intravitreal injections are performed under local anaesthesia (numbing drops) and are usually painless. The procedure is very short, and the patient can return to daily activities afterwards.

I take blood thinners. Can I still develop a vascular occlusion?

Yes. Although blood thinners reduce the general risk of clots, an occlusion can still develop in the retinal vessels for local reasons. For this reason, your medications, systemic conditions and eye findings should be evaluated together.

Does a retinal occlusion increase the risk of heart attack or stroke?

In some cases, yes. Patients who have had a retinal vascular occlusion may have a higher overall vascular risk. Evaluation with specialties such as cardiology and neurology is therefore recommended. The retina is like a mirror of systemic vascular health.

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