A 56 year-old female presents with sudden onset loss of vision in her right eye. She a past medical history of hypertension, hyperlipidema and medication-controlled diabetes mellitus type 2. Her medications include aspirin, ramipril, atorvastation and metformin. On examination she has 6/60 vision in her right eye.Fundoscopic picture is given in the image.What is the most probable diagnosis?
C. Diabetic retinopathy
D. Hypertensive retinopathy
‘Blood and thunder’ retinal appearance is shown in the image.
Central retinal vein occlusion (CRVO)
- old age
- diabetes mellitus
- hypercoagulable state
- atherosclerosis (vein is compressed by adjacent artery)
- retrobular compressive lesions (e.g. thyroid disease, orbital tumour)
- Visual acuity — variable depending on severity and duration since onset
- A Marcus-Gunn pupil may be present if ischemic CRVO (relative afferent pupillary defect = RAPD)
- Red reflex — may be abnormal
- Fundoscopy — large areas of hemorrhage:
- non-ischemic CRVO — dilated tortuous veins, retinal hemorrhages, cotton wool spots, retinal edema, disc swelling.
- ischemic CRVO (more severe) — classic ‘blood and thunder’ appearance from widespread hemorrhages that obscure most fundal details. Neovascularisation.