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Retinal Vein & Artery Occlusions

Retinal vein and artery occlusions are blockages of the blood vessels that supply blood and oxygen to the retina. These blockages are occasionally described as a stroke to the eye. Vein occlusions cause swelling that is very treatable with injections. Artery occlusions are emergencies that also signal stroke risk elsewhere in the body.

Retina photograph showing a retinal vein occlusion

Symptoms of a retinal occlusion

Occlusions almost always affect one eye, and almost always without pain:

  • Sudden painless blur or vision loss in part or all of one eye
  • A dark or gray area in your field of vision
  • Distortion of central vision when the macula swells

Causes & risk factors

Retinal vein occlusions (branched or central) happen when a retinal vein is compressed or clotted, causing blood and fluid to back up into the retina. High blood pressure, high cholesterol, and diabetes are the most common risk factors.

Artery occlusions happen when a clot or plaque fragment blocks blood flow into the retina, most often from the carotid artery or heart, which is why they prompt a stroke-prevention workup.

Branched retinal vein or artery occlusions affect just a branch of the retinal vein or arteries, whereas a central retinal vein or artery occlusion blocks the central "trunk" and its downstream "branches."

Retina photograph showing a branch retinal artery occlusion with pale, whitened retina
A branch retinal artery occlusion from our clinic: the pale, whitened area is retina that has lost its blood supply.

How we diagnose it

Diagnosis is made on a dilated exam, with OCT to measure macular swelling and angiography when we need to map the blocked circulation. For artery occlusions we coordinate promptly with your physician or the hospital for vascular imaging and cardiac evaluation.

How are retinal occlusions treated?

Treatment targets the swelling and the underlying cause:

Anti-VEGF injections
The standard of care for macular swelling from vein occlusions. In-office injections reduce the fluid and, for most patients, meaningfully improve vision over a course of treatment.
Laser treatment
Used in select cases, including eyes that develop abnormal new vessels after an occlusion.
Systemic workup
Every occlusion is a signal about your vascular health. We make sure blood pressure, diabetes, and stroke risk get evaluated, and we report back to your primary care physician.

What to expect

Vein occlusion patients treated consistently often recover substantial vision, though many need injections over an extended period. Artery occlusion outcomes have a worse prognosis as impaired arterial perfusion of affected areas of the retina become permanently damaged within just a few hours. Recent/acute arterial occlusions should be evaluated emergently in the emergency room given the relatively high risk of systemic stroke in the short term following retinal arterial occlusion.

Common questions

Will my vision come back?

For vein occlusions, often substantially, with consistent injection treatment. For artery occlusions the visual prognosis is more guarded, and the immediate priority becomes protecting you from a stroke.

How long will I need injections?

Vein occlusions typically need intravitreal injections for several years but not typically for the rest of your life. Initially you may feel that your doctor is mandating the treatment, but over time you may notice how much the vision improves with treatment, and become very aware when it is time for a treatment.

Is my other eye at risk?

The same vascular risk factors affect both eyes, so controlling blood pressure, blood sugar, and cholesterol levels helps minimize risk to the other eye.

Sources & review

This page is educational and is not a substitute for an examination. Content follows guidance from the American Academy of Ophthalmology and the American Society of Retina Specialists.