Patients in this age group with BRVO usually have underlying systemic conditions
such as hypertension or hyperlipidaemia which should be managed appropriately17.
Those with CRVO present a particular problem in investigation and management.47
Many of these patients will have no identifiable underlying cause despite extensive
investigation including the specialised investigations listed in Table 2. In females the
contraceptive pill is the most common underlying association, and is contraindicated
in patients with retinal vein occlusion. There is debate as to the exact prevalence of
thrombophilic disorders in this patient group as well as appropriate therapy.
Identified inflammatory disease should be treated as appropriate to the condition and
referred for specialist medical advice.

Central retinal vein occlusion in this age group has been thought to have a more
benign outcome in a greater proportion of patients, with spontaneous regression of the
central retinal venous occlusive event being more common. However, at least 20% of
patients develop poor visual outcome with severe neovascular complications.47
Some authorities advocate the use of steroid therapy but this has not been tested in
controlled trials.