

This patient is a 82 year old male.  He is taking medication for hypertension and elevated cholesterol.  He was not aware of any particular eye problem but only thought he needed new reading glasses.

When a retinal artery and a retinal vein cross each other the artery is usually on top of the vein.  The artery has muscle fibers in its wall and the vein does not.    With aging many people develop arteriolsorclerosis ("hardening of the arteries") resulting in the arteries applying pressure on the vein under it. 

In this case, the vein was forced completly shut.  Eventually the pressure of blood entering the vein increased to the point that it ruptured the vein resulting in the large hemorrhage seen in the photo. 

With time the hemorrhage will resolve.  But now there is an inadequate blood flow in the area which leds to hypoxia, or lack of oxygen available to the cells.  In response to the lack of oxygen the cells create chemicals which prompt new blood vesels (neo-vascularization)  to grow into the area.  The new blood vessels that are produced are not like the original blood vessels and often leak more blood.

These days the neovascularization can be treated  with a fairly new drug  (Avastin) which is injected into the eye.  It slows the growth of neovascularization.

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(7 years in a row!)
