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Branch Retinal Vein Occlusion (BRVO): Symptoms, Treatment, & How it Works

Home / Conditions / Branch Retinal Vein Occlusion (BRVO)

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Branch retinal vein occlusion (BRVO) manifests as blurring or vision loss in all or part of one eye. If you experience this, you should seek help as soon as possible.

BRVO is caused by the blockage of small veins (branch veins) in the eye. This blockage causes blood and other fluids to spill into the retina, affecting vision. Serious blockages can eventually cause nerve cells in the eye to die, further impacting vision.

Seeing a doctor as soon as you think you might have BRVO is important. The condition can worsen over time and lead to blindness in the affected eye. Getting help sooner rather than later increases the chance that some of your sight may be restored.

The prognosis for recovery from branch retinal vein occlusion is mixed. The condition is incurable, but most people will see an improvement in vision with treatment. However, some people will see no change in vision, even with treatment.

To try and control your risk of BRVO, maintain a healthy circulatory system, especially as you get older. Proper diet, exercise, and weight maintenance can help, as does avoiding behaviors with a negative impact on circulation, such as smoking.

Branch Retinal Vein Occlusion (BRVO)

perspective of someone with blurry vision
Branch retinal vein occlusion (BRVO) is a condition caused by vein blockages (occlusions) in the eye, which can blur vision or even lead to total vision loss in the affected area. It is generally totally painless.

If the condition does not affect an area near the center of the eye, it may occur with no symptoms or minimal symptoms. This can cause the condition to go undetected. In rare cases, undetected vein occlusions may lead to visual floaters, as blood leaks into the eye.

One 2011 study has estimated over 16 million people worldwide were affected by BRVO, and there is little reason to think the number affected has significantly decreased since then. It is one of the most common causes of retinal vascular abnormality, which in turn can lead to serious vision loss.

Signs and Testing for BRVO

The earliest signs of branch retinal vein occlusion are the symptoms noted above. Even if you experience only mild swelling or occasional visual floaters, you should see an ophthalmologist. BRVO is not curable but it is treatable. Identifying it is important, as it can get worse with time.

A doctor testing for BRVO can perform tests to more conclusively confirm if you have the condition. First, a fluorescein angiography (FA) test is performed. This involves injecting special dye into the arm, which allows a specialized camera to more easily see how your blood is circulating. A doctor will then look for the following in your eye:

  • Poor circulation
  • Swelling
  • Abnormal growth of new blood vessels in the retina

Once a doctor has determined if you likely have BRVO, an optical coherence tomography (OCT) test may be performed. This noninvasive imaging test uses light to make an 3D image of your eye that will be useful in your evaluation and treatment.

How Does BRVO Happen?

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Your eye has one main artery and one main vein. These both branch out, helping to supply the eye with blood. Whether it’s due to a blood clot, narrowed blood vessels, or a thickened artery crossing over a branch vein, BRVO happens when something begins to block a branch retinal vein.

Blood and other fluid can then lead out of the blocked vein, which can swell the macula (an area of the eye very important for detailed vision). It can also result in the macula receiving inadequate blood flow. This is called macular edema.

The symptoms commonly associated with branch retinal vein occlusion are due to this effect on the macula. This is also why it’s important to see a doctor if you think you might have this condition. Poor circulation and minute amounts of swelling may still do some permanent damage. You could potentially lose much more vision in the affected eye without treatment as the macula is further affected.

Some conditions that make one more likely to deal with BRVO include the following:

  • High blood pressure
  • Obesity
  • Diabetes
  • Heart disease
  • Blood clotting issues
  • Glaucoma
  • Age

Most people affected by BRVO are over the age of 50. Data does not suggest that there is a difference in risk between men and women, and people of different races are also generally affected at similar rates.

Rare Complications

Although rare, branch retinal vein occlusion can sometimes lead to the development of abnormal new blood vessels (neovascularization). This generally occurs when BRVO affects an area of the eye that does not significantly affect vision, causing it to go undetected. This is why any visual floaters, as discussed above, should not be ignored.

Left untreated, neovascularization can lead to a host of vision problems.

Treatment for BRVO

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BRVO is incurable. Even with treatment, not every patient will see improvement. However, most people will see at least some improvement in their vision.

While vision may never fully recover to original levels, the jump in vision quality will often be significant with treatment.

The purpose of this treatment is not necessarily to treat the blockage itself, but instead to reduce macular edema and prevent it from worsening. If the macular edema can be improved, vision can often be at least partially restored.

A doctor may decide you need focal laser treatment. This is when a very precise laser is used to stop some fluid leaks around your macula through controlled burns. While laser eye surgery may sound intimidating, it is generally painless. Preventing leakages can stop the condition from worsening.

A doctor may also determine that injecting anti-VEGF (elevated vascular endothelial growth factor) drugs into the affected eye is a good course of action. While the procedure is not without discomfort, local anesthetic eye drops are applied first to numb the eye before the injection.

If anti-VEGF drugs are not working for you, a doctor may treat you with injections of steroids. This can cause other eye problems, but your doctor will be aware of this and help you manage your risks.

Managing Risks

While not every risk factor of BRVO is within your control, such as age, others are. Generally speaking, engaging in behaviors and habits that are healthy for your heart and circulatory system will help to reduce your risk of getting BRVO.

Some behaviors that can help control your risk include:

  • Maintaining a low-fat diet.
  • Keeping a healthy weight.
  • Regularly exercising.
  • Avoiding activities that negatively affect your circulatory system, like smoking.

References

  1. Retinal Vein Occlusion. (April 1, 2019). MedlinePlus.
  2. What Is Branch Retinal Vein Occlusion (BRVO)? (November 16, 2018). American Academy of Ophthalmology (AAO).
  3. Branch Retinal Vein Occlusion (BRVO) Treatment. (November 16, 2018). American Academy of Ophthalmology (AAO).
  4. The Prevalence of Retinal Vein Occlusion: Pooled Data from Population Studies from the United States, Europe, Asia, and Australia. (February 1, 2011). American Academy of Ophthalmology (AAO).
  5. Branch Retinal Vein Occlusion. (2016). American Society of Retina Specialists.
  6. Glossary. American Society of Retina Specialists.
  7. Who Is at Risk for Branch Retinal Vein Occlusion (BRVO)? (November 16, 2018). American Academy of Ophthalmology (AAO).

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