What is the most common cause of central retinal vein (CRV) thrombosis?

From the Guidelines

The most common cause of central retinal vein (CRV) thrombosis is glaucoma, as well as systemic conditions such as carotid occlusive disease and sleep apnea. According to the most recent study 1, risk factors for CRVO include carotid occlusive disease and sleep apnea as well as glaucoma. The study also mentions that elevated homocysteine levels have been associated with CRVO in selected cases.

Key Risk Factors

• Glaucoma
• Carotid occlusive disease
• Sleep apnea
• Elevated homocysteine levels

It's essential to note that the risk factors for CRVO differ from those for branch retinal vein occlusions (BRVO), which are more likely associated with local vascular factors, such as arterial-venous crossing changes, and systemic conditions like arterial hypertension, hyperlipidemia, diabetes, and coronary artery disease 1.

Management and Prevention

Management of CRVO involves treating the underlying cause, as well as any resulting complications, such as macular edema or neovascularization. The study 1 emphasizes the importance of identifying patients at risk for developing RVO, encouraging management of potential risk factors, and monitoring for signs of posterior or anterior segment neovascularization and neovascular glaucoma following all RVOs.

In terms of prevention, controlling systemic blood pressure and diabetes, as well as managing glaucoma and ocular hypertension, can help reduce the risk of developing CRVO 1. Additionally, increasing primary care awareness of the higher risk of cardiovascular and stroke complications in patients presenting with RVO can help prevent further morbidity and mortality.

Overall, prompt recognition and management of CRVO and its associated risk factors are crucial to preventing long-term vision loss and reducing the risk of cardiovascular and stroke complications.

From the Research

Causes of Central Retinal Vein Thrombosis

• The most common cause of central retinal vein (CRV) thrombosis is not explicitly stated in the provided studies, but several factors are associated with an increased risk of retinal vein occlusion, including:
  • Deficiency of anticoagulant proteins, especially protein C 2
  • Hypercoagulable states, such as factor V Leiden mutation 3
  • Systemic diseases, such as lung cancer 4
  • Inflammatory or infectious conditions, such as ethmoidal rhinosinusitis 5
• Protein C deficiency is found to be more common in patients with central retinal vein occlusion compared to those with branch retinal vein occlusion 2
• Other factors, such as antithrombin III and protein S deficiencies, may also play a role in the etiology of retinal vein occlusion, although their association is less clear 2