A 56-year-old female presented with sudden decreased vision in her right eye for 3-4 days. On examination, she was found to have a right eye hemiretinal vein occlusion. Fundus photos showed flame-shaped hemorrhages in the superior hemisphere of the right eye. OCT showed retinal thickening. The provisional diagnosis was right eye hemiretinal vein occlusion. Hemiretinal vein occlusion is a variant of central retinal vein occlusion where one of the major branches of the central retinal vein is blocked near the optic disc, affecting half of the retina. Management of macular edema following hemiretinal vein occlusion typically follows guidelines for branch retinal vein occlusion.
2. Patient Details
Name : Nazmabegum Khan
Age: 56 yrs
Sex: Female
Religion: Muslim
Address: Taloja
3. History
Patient came with the chief complaints of diminution
of distant as well as near vision in the right eye, since
3-4 days which was sudden in onset, non-progressive
and painless in nature
History of spectacle usage since 15 years, last
corrected 2 years ago
No history of ocular trauma
No history of ocular surgery/procedure.
No history of past COVID infection.
K/c/o Type II diabetes mellitus since 10 years on oral
medication
K/c/o Thyroid disorder since 5 years on medication
4. Visual Acuity
Distant Vision
(Snellen’s chart)
Right Eye Left Eye
Unaided
Pinhole
Fc at 2m
6/24
6/18
NI
Aided
S/A
6/18
+1.50 DS/ -2.00 DC * 10
6/9
-0.75 DS/ -3.50 DC * 10
Near Vision Right Eye Left Eye
Unaided N36 N10
Aided
S/A
N18
+2.25 DS
N6
+2.25 DS
Colour Vision 17/17 plates 17/17 plates
Amslers Grid Normal Normal
5. Ocular
Examination
Slit Lamp Examination OD OS
Eyelid Normal Normal
Conjunctiva Normal Normal
Sclera Normal Normal
Cornea Arcus senilis Arcus senilis
Anterior chamber Normal depth Normal depth
Iris Normal Normal
Pupil 3mmRRR; No RAPD 3mmRRR; No RAPD
Lens SIMC: NSII SIMC: NSII + Diffuse
PSC
6. OD OS
IOP 12 mmHg 12 mmHg
Sac Patent Patent
Extraocular movements Free, full and painless in
all gazes
Free, full and painless in
all gazes
7. Fundus
Examination
OD OS
Distant Direct
Ophthalmoscopy
Red reflex seen Red reflex seen with diffuse
media opacity
Media Clear Clear
Optic Disc Size: Normal
Shape: Normal
Colour: Yellowish orange
Margins: Well-defined
Neuroretinal rim: Healthy,
temporal crescent+
Size: Normal
Shape: Normal
Colour: Yellowish orange
Margins: Well-defined
Neuroretinal rim: Healthy,
temporal crescent+
C:D ratio 0.5:1 CDR 0.5:1 CDR
Blood Vessels Dilated and tortuous
vessels superiorly
Scattered flame-shaped
haemorrhages in superior
hemisphere
A:V ratio = 2:3, tortuous
Foveal Reflex Details not seen Dull
Macula Flame-shaped
haemorrhages
Normal
8. OD OS
Indirect Ophthalmoscopy:
Peripheral Retina
Scattered flame-shaped
haemorrhages in superior
hemisphere
Normal
90D slit lamp biomicroscopy with
red-free filter
Scattered flame-shaped
haemorrhages in superior
hemisphere
No evidence of RNFL defects
or retinal ischemia
Normal
13. Provisional
Diagnosis
Based on history and clinical examination : Patient
Mrs.Nazmabegum Khan, 56 years old female has right eye
hemiretinal vein occlusion
14. • Retinal venous occlusive disease, which includes central retinal vein occlusions
(CRVOs), hemiretinal vein occlusions (HRVOs), and branch retinal vein
occlusions (BRVOs), is the second most common retinal vascular
disorder after diabetic retinopathy.
• Vein occlusions typically affect persons older than 50 years of age who may
typically have associated hypertension, cardiovascular disease, diabetes mellitus,
and/or glaucoma.
• Variant of CRVO; May be ischaemic or non-ischaemic
• Occlusion of the superior or inferior branch of the central retinal vein (CRV)
• Hemispheric occlusion - blocks a major branch of the CRV at or near the optic disc.
• Hemicentral occlusion – involves one trunk of a dual-trunked CRV that has
persisted in the anterior part of the optic nerve head as a congenital variant; less
common
• Extensive retinal ischaemia implies a risk of neovascular glaucoma
• HRVO and CRVO are believed to result from thrombus formation near the lamina
cribosa
• In approximately 20 percent of eyes, the veins draining the inferior and superior
halves of the retina merge posterior to the lamina cribrosa, such that one of these
two veins may be spared by the occlusive process resulting in a HRVO. The
pathophysiology of HRVO mimics CRVO, but the clinical findings and
complications are intermediate between CRVO and BRVO. For most clinicians,
macular edema following HRVO is managed similar to that following BRVO,
while CRVO guidelines are used for panretinal photocoagulation.
Discussion
