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Retinal Vein Occlusion: Causes, Symptoms, and Treatment
Risk Factors and Who Is Affected
Retinal vein occlusion can affect people of many backgrounds, but certain conditions and characteristics significantly raise the risk. Identifying these risk factors is important both for prevention and for managing overall health after a diagnosis.
Older age is the most significant risk factor for retinal vein occlusion. The vast majority of RVO cases occur in people over the age of 55, and the risk increases with each passing decade.
Hypertension (high blood pressure) is the strongest systemic risk factor for RVO. It contributes to vessel wall changes and altered blood flow that make blockages more likely. People with uncontrolled high blood pressure face a substantially higher risk of developing a retinal vein occlusion than those with well-managed blood pressure.
Diabetes damages blood vessels throughout the body, including those in the retina, and is associated with a higher risk of RVO. Cardiovascular disease also raises risk, as conditions affecting blood vessel health throughout the body can contribute to the same vessel wall problems that cause retinal vein blockages.
Several additional factors are linked to an elevated risk of retinal vein occlusion.
- Glaucoma, a condition involving increased pressure inside the eye, has been associated with a higher risk of RVO.
- Elevated cholesterol can contribute to blood vessel damage and altered clotting.
- Increased body weight is associated with higher RVO risk.
- Blood clotting disorders may be relevant, particularly in younger patients without typical risk factors.
Symptoms and Warning Signs
Recognizing the symptoms of retinal vein occlusion early can make a critical difference in how much vision is preserved. Many people first notice something is wrong when their vision changes suddenly and without any pain.
The most common symptom is a sudden, painless change in vision in one eye, often developing over hours or a few days. With BRVO, only part of the visual field may be affected. With CRVO, the vision loss tends to be more widespread because the main vein supplying the entire retina is blocked.
Some people notice new or increased floaters, which are dark spots, strings, or cobweb-like shapes that move across the field of vision. In some cases, floaters caused by a small vitreous hemorrhage may be the first noticeable sign of a vein occlusion that was otherwise silent.
Most cases of RVO are completely painless. However, patients who develop neovascular glaucoma as a complication of severe CRVO may experience eye pain, redness, and irritation. These symptoms indicate a serious complication that requires urgent evaluation.
If you experience any sudden change in vision, a new wave of floaters, or a shadow or curtain moving across your vision, contact a Retina Specialist or seek emergency care right away. Delay in treatment can result in permanent vision loss.
How Retinal Vein Occlusion Is Diagnosed
Diagnosing RVO involves a thorough examination of the retina combined with specialized imaging. Our team uses advanced in-office technology to evaluate the extent of the blockage, identify complications, and guide treatment decisions.
A Retina Specialist begins with a comprehensive dilated eye exam. Eye drops are used to widen the pupil, allowing a clear view of the retina. The specialist looks for characteristic signs of vein occlusion including swollen veins, retinal hemorrhages, and cotton-wool spots, which are white patches that indicate areas of reduced blood flow.
Optical coherence tomography (OCT) is a non-invasive imaging test that produces detailed cross-sectional images of the retina. It allows our team to precisely measure retinal and macular thickness, detect fluid buildup, and monitor how the retina responds to treatment over time. OCT is one of the most important tools we use for ongoing management of RVO.
During fluorescein angiography, a special dye is injected into a vein in the arm and travels through the retinal blood vessels. A camera captures rapid photographs as the dye moves through the retina. This test reveals areas of blocked flow, leaking vessels, and abnormal new blood vessel growth, helping our team map the full extent of the occlusion.
We also offer OCT angiography, fundus photography, wide-field imaging, and B-scan ultrasound as part of our complete diagnostic capabilities. Because RVO is closely linked to systemic health, blood testing may be recommended to check for high blood pressure, diabetes, elevated cholesterol, and clotting disorders. Coordinating care with a primary care physician is an important part of the overall management plan.
Treatment Options for Retinal Vein Occlusion
The goal of treatment is to reduce macular swelling, protect remaining vision, and prevent serious complications. Our Retina Specialists tailor a treatment plan based on the type and severity of the occlusion and how your eye responds over time.
Anti-VEGF injections are the primary treatment for macular edema caused by RVO. These medications block the VEGF protein that drives fluid leakage and abnormal blood vessel growth. The medication is delivered as an intravitreal injection, meaning it is administered directly into the eye in a brief, well-tolerated in-office procedure.
The anti-VEGF medications used to treat RVO include Avastin (bevacizumab), Lucentis (ranibizumab), Eylea (aflibercept), and Vabysmo (faricimab). Vabysmo targets both VEGF and a second protein called angiopoietin-2, and may allow for longer intervals between injections in some patients. Our team will recommend the medication best suited to your individual situation.
For patients with chronic macular edema that does not respond adequately to anti-VEGF therapy, a steroid implant such as Iluvien (fluocinolone acetonide) may be considered. These implants are placed inside the eye and slowly release medication over an extended period. Steroid treatments can carry risks including elevated eye pressure and earlier cataract formation, and our team carefully weighs those risks against the potential benefits for each patient.
Laser photocoagulation (the application of a focused laser beam to the retina) was once the standard treatment for BRVO. Anti-VEGF injections have largely replaced laser as the first-line approach, but laser therapy still plays a role in certain situations. It may be used to treat areas of the retina affected by ischemia or to address abnormal new blood vessel growth that has not responded to injections alone.
Treating the eye is only part of the picture. Controlling blood pressure, blood sugar, and cholesterol is essential for reducing the risk of a second occlusion and for overall cardiovascular health. Our team works collaboratively with patients' primary care physicians to make sure systemic risk factors are being addressed alongside retinal care.
What to Expect During and After Treatment
Starting treatment promptly gives your retina the best chance for recovery. Knowing what the process involves can help you feel prepared and confident at each stage of care.
Intravitreal injections are performed in our office. The eye is numbed with anesthetic drops beforehand, and the injection itself takes only a few seconds. Most patients feel mild pressure rather than sharp pain. Treatment typically begins with injections at regular intervals, often monthly during an initial phase, and the schedule is adjusted based on how the eye responds.
How much vision can be recovered depends on the type and severity of the occlusion, the amount of retinal damage present, and how quickly treatment was started. Many patients with BRVO experience meaningful improvement with prompt anti-VEGF treatment. Outcomes with CRVO can be more variable, especially when significant ischemia has occurred.
It is important to have realistic expectations. Some patients regain much of their lost vision, while others may see partial improvement or stabilization. Our team will discuss what is realistic for your specific situation based on your imaging and examination findings.
Even after vision stabilizes, ongoing follow-up is essential. Macular edema can return, and new complications can develop months or years after the initial event. Regular visits allow our team to detect changes early and adjust treatment before vision is affected. At every visit, we perform serial retinal photo comparisons to track changes in your retina over time, giving us an accurate and documented record of how your condition is evolving.
Living Well After Retinal Vein Occlusion
Managing daily life after an RVO diagnosis involves both protecting your eye health and taking care of your overall wellbeing. Small, consistent changes can make a meaningful difference in long-term outcomes.
Since RVO is deeply connected to cardiovascular and metabolic health, managing blood pressure, blood sugar, and cholesterol through diet, exercise, and prescribed medications is one of the most important things you can do. Avoiding smoking is also strongly recommended, as smoking damages blood vessels throughout the body and increases the risk of further vascular events.
Some patients experience lasting changes in their vision even after treatment. Low-vision aids such as magnifying devices, improved lighting, and large-print materials can help with daily tasks. Our team can provide guidance on vision rehabilitation resources and help connect you with appropriate support.
Having RVO in one eye increases the risk of developing it in the other eye, particularly if underlying risk factors remain uncontrolled. Regular retinal examinations are important for catching early signs of a new occlusion. Report any sudden vision changes in either eye to a Retina Specialist immediately, without waiting for a scheduled appointment.
Frequently Asked Questions
The following answers address common questions that go beyond the basics, helping you navigate decisions about your care and know when to act quickly.
It is rare for RVO to affect both eyes simultaneously. Most episodes involve one eye at a time. However, the risk of developing an occlusion in the second eye is real, particularly when the underlying risk factors such as high blood pressure or diabetes are not well controlled. This is one of the key reasons ongoing systemic management and regular monitoring of both eyes are so important after a first diagnosis.
There is no single answer because treatment duration varies considerably between patients. Some people need injections for only a few months, while others require ongoing treatment for a year or more to keep macular edema from returning. Your Retina Specialist will extend or reduce the interval between injections based on your imaging results and visual response, aiming to find the least frequent schedule that still keeps your retina stable.
Retinal vein occlusion shares many of the same underlying risk factors as stroke and heart disease, including high blood pressure, diabetes, and elevated cholesterol. While RVO is not a stroke, it is a vascular event and can be an important signal that cardiovascular risk factors need closer attention. A diagnosis of RVO is a good reason to discuss your overall cardiovascular health with your primary care physician if you have not already done so.
Recurrence of macular edema is common, and it does not mean treatment has failed. In many cases, resuming or intensifying injections can bring the swelling back under control. If one medication is less effective over time, your Retina Specialist may consider switching to a different anti-VEGF agent or adding a steroid implant. Regular follow-up visits are essential precisely because they allow us to catch recurrence early, often before you notice a change in your vision.
Yes, actively managing the systemic conditions that contribute to RVO can meaningfully reduce the risk of a second event. Keeping blood pressure within a healthy range is especially important, as it is the strongest modifiable risk factor. Controlling blood sugar and cholesterol, maintaining a healthy weight, staying physically active, and not smoking all support the health of your retinal blood vessels. These changes benefit your overall cardiovascular health as well, making them worthwhile beyond the protection they offer to your eyes.
Go immediately to a Retina Specialist or emergency room if you experience a sudden loss of vision in one eye, a rapid increase in floaters or flashes, or a dark curtain or shadow crossing your visual field. These symptoms can indicate a retinal vein occlusion, retinal detachment, or other urgent condition where time directly affects how much vision can be saved. It is always better to be evaluated and reassured than to wait and risk permanent damage.
See Our Team at Atlantic Retina Center
Atlantic Retina Center focuses exclusively on the retina, vitreous, and macula, bringing dedicated expertise to every patient we see. Our fellowship-trained, ABO board-certified Retina Specialists are experienced in diagnosing and treating retinal vein occlusion with the most current approaches available. If you are experiencing vision changes or have been referred for a retinal evaluation, we welcome you to connect with our team at one of our offices across the Delmarva peninsula.