Comments and Conclusions

  • Most patients with vein occlusions are elderly with systemic disorders such as hypertension and diabetes.2,3,4
  • In contrast, our patient is young, trim and fit, and without any identifiable systemic disorder.
  • More than two decades earlier at the age of 30, he presented with a CRVO as a young, healthy adult, a condition sometimes also termed papillophlebitis or inflammation of the central retinal vein at the level of the optic nerve head.
  • The systemic workup then (and repeated now) was non diagnostic.
  • Without any known systemic disorders, glaucoma is perhaps the missing link to the multiple vein occlusions.5
  • Although the correlation of central retinal vein occlusion to a large cup to disc ratio and to glaucoma is well documented, the pathophysiology of this connection is not well understood.6 The possible link is less well documented in BRVO.7
  • Various potential treatment options for the recent vein occlusion have been discussed with the patient.
  • In our patient and in similar cases, setting a lower target intra-ocular pressure appears prudent. One or more SLTs, in addition to topical eye drops, is recommended.8
  • Although papillophlebitis or CRVO in a young healthy adult is thought by many to be relatively benign, one long term follow up study finds increased morbidity and mortality in these patients.