Revisiting Retinal Vein Occlusion: An Etiologic Classification for Enhanced Patient Management

Retinal vein occlusion (RVO) represents one of the most prevalent retinal vascular disorders and continuously stands as a leading cause of visual impairment worldwide. Conventional classification systems for RVO-predominantly featured by anatomical site as central, hemi-retinal, or branch retinal vein occlusion-often fail to reflect the underlying etiologic factors exerting crucial influence on individualized patient management. In an effort to mitigate this gap, we propose an etiologic classification that divides retinal venous stasis disorders-used here to describe a pathophysiological continuum of impaired retinal venous outflow, ranging from early venous congestion to retinal vein occlusion-into four distinct groups: (1) intrinsic retinal venous pathology, (2) local venous compression at arteriovenous crossing points, (3) venous congestion secondary to translaminar pressure gradient abnormality, and (4) venous outflow obstruction correlated with cavernous sinus pathology. To introduce and illustrate this new classification, we conducted a narrative literature review and compiled retrospectively identified illustrative clinical cases. As underscored by our findings, differing underlying etiologies necessitate distinct diagnostic evaluations and tailored therapeutic interventions in spite of similar clinical fundus presentations. For example, RVO cases stemming from systemic inflammatory diseases require targeted immunologic management, whereas those associated with elevated intracranial pressure demand neurological assessment and appropriate intervention. This etiologically oriented approach complements traditional anatomical classifications by promoting comprehensive systemic evaluations and personalized treatment strategies. We propose that implementing this etiologic classification could not only contribute to ameliorated clinical outcomes but also encourage its further evaluation for potential integration into routine ophthalmological practice.