Central Retinal Vein Occlusion (CRVO)

Fundus photograph and red-free image (right eye)

Retinal photos show a “blood and thunder” appearance with widespread retinal haemorrhages and dilated, tortuous veins. The disc margins are poorly defined indicating likely disc oedema.

Stereoscopic image (right optic disc)

Please use a stereoviewer or 15 prism dioptres base out to view the image.

A stereoscopic view of the optic disc shows it to be elevated. The disc is also hyperaemic in appearance.

Green separation image (right eye)

Widefield imaging shows the extent of the retinal haemorrhages.

Spectralis OCT line scans (right macula)

OCT shows small intra-retinal cystic spaces indicating the presence of macular oedema.

Cirrus RNFL Analysis

RNFL analaysis shows increased RNFL thickness in the right eye, consistent with disc oedema. Note also the RNFL thinning in the left eye due to previously diagnosed glaucoma.

Fundus photograph and red-free image (left eye)

Fundus photography shows an acute central retinal vein occlusion with “blood and thunder” appearance including widespread intraretinal flame-shaped, blot and dot haemorrhages, mild venous dilatation and tortuosity as well as disc and likely macula oedema.

Disc photo (left eye)

Zoomed in image of the optic disc highlights the degree of oedema and haemorrhages causing complete obscuration of the disc margins and an elevated appearance.

Optomap widefield image (left eye)

Optomap imaging shows the widespread range of the haemorrhages and venous dilatation / tortuosity which extend into the mid peripheral retina in all 4 quadrants.

Spectralis OCT volume and line scans (left optic disc)

OCT imaging shows the extent of the optic disc oedema highlighted by the elevation of the margins and presence of cystic spaces.

Spectralis OCT volume and line scans (left macula)

OCT reveals macula thickening, intraretinal cystic spaces and loss of the typical foveal architecture. There was no sign of subretinal fluid.

Optos Widefield and green separation image (right eye)

Optomap imaging shows the widespread range of the haemorrhages and venous dilatation / tortuosity extending through all four quadrants. Indistinct disc margins and a hyperaemic optic disc may also be noted.

Fundus autofluorescence (FAF) imaging

FAF imaging highlights the widespread retinal haemorrhages.

Cirrus OCT line scan (right macula)

OCT imaging shows intra-retinal cystic spaces, indicating the presence of macular oedema.

Fundus photograph (right eye)

The right posterior pole photo showed extensive dot, blot and flame shaped haemorrhages, venous dilatation and tortuosity. The optic disc appears hyperaemic from the superior to inferior extent with corresponding indistinct margins. The central macula showed a loss of the typical reflex.

Stereoscopic disc photo

Note: (View with 15 dioptres base out prism (combined) or stereoviewer)
Stereoscopic examination of the optic disc showed mildly elevated margins with reduced definition and subtle vessel obscuration in the superior temporal quadrant consistent with disc oedema.

Green separation images (acute presentation)

Widefield green separation images showed the widespread extent of the haemorrhages and venule calibre changes in all four quadrants.

Optomap images - initial and follow-up visits

These comparison Optomap images show that the majority of the retinal haemorrhages and venous changes have resolved by the 12 month follow up visit. However, temporal peripheral blot haemorrhages, collateral vessels, microaneurysms and sheathed vessels were identified.

Green separation image (follow-up visit)

Some examples of the peripheral vascular changes are labelled on this image. These include blot haemorrhages (green arrows), collateral vessels (yellow arrow),, microaneurysms (red arrows) and sheathed vessels (blue arrows).

Spectralis OCT volume scans (right macula)

OCT scans at baseline showed areas of inner retinal thickening and small cystic spaces temporal to the fovea. Supero – extrafoveal showed a thin inner retina corresponding to the previous branch vein occlusion noted in his history. At the one year follow up, there is a reduction in overall retinal thickness, though there is persistent cystic spaces temporally.

Spectralis OCT line scans (right optic nerve)

OCT scans at baseline show an oedematous ONH with resolution by the 12 month visit.

Cirrus RNFL analysis (initial and 12 month follow-up)

RNFL analysis showed a thick RNFL at baseline with the typical "rainbow fringes" (on the RNFL thickness map) associated with disc oedema. The follow-up scan showed reduction in RNFL thickness consistent with the resolution observed fundoscopically and on OCT. Additionally, there is a thinning of the RNFL, supero-temporally, (highlighted on the deviation map) in the right eye that corresponds to the location of the previous BRVO.

On the follow up scan, there is a thinning of the RNFL supero-temporally in the right eye that corresponds to the location of the previous BRAO (for more information about this finding, please refer to the chapter on BRAO within this atlas).

Fundus photographs (left eye - top, right eye - bottom)

Retinal photography of the left eye showed evidence of a resolving CRVO. Note, the asymmetrical vascular (venous dilatation / tortuosity) appearance between the eyes, blurred nasal disc margins with fine collateral vessels nasally, AV nicking, dot and blot haemorrhages.

Optomap and green separation image (left eye)

Optomap imaging of the left eye demonstrated signs of resolving central retinal vein occlusion including venous tortuosity in all quadrants, numerous intraretinal dot and several blot haemorrhages in the posterior pole and more extensive haemorrhages the temporal retinal periphery in the midst of sheathed vessels and collateral vessel formation.

Cirrus RNFL analysis

OCT RNFL analysis shows mild relative thickening of the retinal nerve fibre layer in the left eye as well as subtle elevation of the optic nerve head (on the B-scan) suggesting residual optic disc oedema.

Fundus photograph and red free image - initial presentation (right eye)

Fundus photgraphy shows signs consistent with a right CRVO: venule dilation, tortuosity as well as haemorrhages and cotton wool spots. The disc was hyperaemic with indistinct margins.

Fundus photograph and red free image - 2 month follow-up (right eye)

At the 2 month follow-up, there is still venule dilatation / tortuosity however there are significantly fewer retinal haemorrhages. Cotton wool spots were more easily identifiable at this visit. The optic disc appeared less hyperaemic with more distinct margins and the presence of collateral vessels nasally and inferiorly.

Optos green separation images (initial and 2 month follow up)

Widefield imaging shows increased vessel tortuosity at both visits. At the initial visit, retinal haemorrhages may be seen in all four quadrants however these have largely re-absorbed at the 2 month follow-up visit.

Fundus photograph (right posterior pole)

Fundus photos show tortuous and dilated veins in the right eye with crossing changes also identified (for more information about AV crossing changes, please refer to the chapter on hypertension in this atlas).

Incidental findings also include drupelets at both maculae, microaneurysms and dot haemorrhages

Optic disc photo (right eye)

The disc photo shows collateral vessels.

Optomap and green separation images (right eye)

Widefield imaging show widespread tortuosity of the veins.

Cirrus OCT line scan (right inferior macula)

An OCT line scan through the superior edge of the disc shows the atypical vessels are intraretinal, differentiating them as collateral vessels.

Cirrus OCT angiography (right eye)