This patient is a 28YO who presented with hand motion vision from an acute central retinal vein occlusion (CRVO).
The poor vision and extent of retinal hemorrhages would suggest an ischemic occlusion. However, fluorescein angiography shows good peripheral perfusion, indicating a non-ischemic CRVO.
Angiography also shows marked foveal hypofluorescence, which may be due to a filling defect (ischemia) or a blockage. The contour of the dark, hypofluorescent macula precisely corresponds to the macular hemorrhage noted on the color photograph, indicating that this is due to blockage rather than ischemia.
Learning Points:
Although CRVOs can occur in younger patients, it is sometimes prudent to look for other systemic causes, including hypercoagulable conditions and hyperviscosity syndromes.
See Liu et al. Retina 2018;38;1175-1179 and Bremond-Gignac et al Retina 2020;40;1339-1343 for further discussion of the debate over the need for a medical workup in younger patients with CRVO.
