I'm not sure in how much detail the diagnosis has been explained to you. CRVO refers to a blockage in the circulation of blood in the retina. In a CRVO the blockage occurs at the point where the blood leaves the retina to exit the eye. This blockage is caused in most cases by a blood clot. In practical terms, it amounts to having something akin to a stroke, but in the retina rather than the brain.
CRVOs can vary in severity, and it is difficult to judge this without seeing the patient in person. Some spontaneous recovery is possible in some cases (20% approx). Another 20% tend to remain the same, and in many cases the vision can deteriorate further.
The main reasons for visual deterioration in CRVOs include:
1. oedema (swelling) of the retina
2. ischaemia (retina not getting enough blood/oxygen)
Oedema can be relieved in some cases by steroid injection into the eye, or Avastin
injection. However, if there is ischaemia of the central retina, vision is unlikely to improve
In the presence of ischaemia, the eye can develop a painful type of glaucoma
called rubeotic glaucoma. This is because ischaemic retina produces growth factors that cause compensatory growth of new blood vessels. Unfortunately these vessels tend to grow abnormally in undesirable parts of the eye, where they can obstruct the circulation of fluid inside the eyeball and cause the pressure to rise. This scenario is usually treated by laser (known as PRP laser) to shutdown the ischaemic parts of the retina. This procedure does not improve vision but can prevent the eye becoming painful in the long term.
Given that PRP has been discussed by your docs, you mum may have an ischaemic type of CRVO. Unfortunately there is currently no effective treatment to restore central retinal circulation in ischaemic cases.
Importantly, you mother should have investigations to look for (and address) risk factors for vein occlusion. These include diabetes, hypertension, cholesterol, smoking. The eye pressures should also be checked. The main aim of all this is to minimise the chances of the good eye developing a CRVO. However, in many patients we don't find a clear risk factor and the CRVO is attributed to 'bad luck.'
The antidepressants are best prescribed by you GP. In certain cases, some antidepressants can affect pupil tone and eye pressure, but it is difficult to know whether your mother is susceptible to these interactions without examining the eyes in person. Your GP should be able to liaise with your local ophthalmologist
to work out something more suitable.
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