This patient has a classic case of Central Retinal Vein Occlusion secondary to venous stasis. The ischemia caused by this condition has led to subsequent rubeosis of the left iris as well.

The patient was referred for immediate reassessment of his carotids, and a panretinal photocoagulation was scheduled to be performed a few days later. This PRPC was performed in an attempt to decrease the ischemia and thereby slow or stop the inducement of new vessel growth in the iris (already present), and retina (real risk).

It is interesting to note the small area of the hemorrhage, just beyond the disk margins, which is a contrast to the huge 'painted' retinal appearance usually seen in CRVO (almost looks like papilledema).

The rubeosis drives home the point that long term management means watching for signs of anterior segment ischemia as well as retinal ischemia. Another unusual finding is the ischemia despite the relatively small amount of hemmorhage and good vision. Such ischemia is more often associated with 20/200 vision or worse.

In addition to PRPC, treatment of ischemic CRVO often involves the reduction of IOP, and anticoagulants.