Examination and Management

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1. Document visual acuity.

2. Afferent pupil defect (see p. 7) in severe cases only.

3. Fundus examination - whole retina affected in CRVO (Fig. 4.5) only part of retina affected in BRVO (Fig. 4.4).

4. Retinal hemorrhages - may be few or widespread often with cotton wool spots (patchy white retinal lesions secondary to ischemia) and blurred disc margins.

5. Raised intraocular pressure - over 21 mmHg - predisposes to vein occlusion - if you do not have experience measuring this, you are unlikely to obtain an accurate reading - leave to the ophthalmologist. If a tonopen (portable tonometer) is available - then use and document pressure.

6. Measure and treat blood pressure as required.

7. Check urine and random blood for diabetes.

Fig. 4.4 A superotemporal branch vein occlusion - the hemorrhages and edema affect the macula region and vision is reduced. If the blockage is more peripheral vision may be spared. Note the cotton wool spots indicating ischemia.
Fig. 4.5 Central retinal vein occlusion.

8. Send blood for FBC, plasma electrophoresis, blood sugar and cholesterol.

9. Advise patient to stop smoking.

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