Clinical Report: Dehydration During Exercise May Contribute to CRVO

Overview

A 38-year-old woman developed mild, perfused central retinal vein occlusion (CRVO) in her left eye after high-intensity exercise; the authors suspected relative dehydration as a possible contributing factor. Without pharmacologic treatment, her retinal findings improved by 1 month and resolved by 10 months, with visual acuity remaining 20/20. The single case does not establish a causal relationship between exercise, dehydration, and CRVO.

Background

CRVO predominantly affects older adults, although approximately 10% to 15% of cases occur in people younger than 50 years. Evaluation distinguishes perfused from ischemic disease and assesses complications such as macular edema and neovascularization. The American Academy of Ophthalmology notes that systemic testing decisions may require individual consideration, including possible hypercoagulable evaluation in patients younger than 50 years. The Royal College of Ophthalmologists identifies conditions that increase blood viscosity or slow or disrupt venous flow among major associations with retinal vein occlusion.

Data Highlights

Key Findings

• Investigators diagnosed mild perfused CRVO in the left eye after examination, OCT, and fluorescein angiography.

• The patient reported no personal or family history of glaucoma, hypertension, hyperlipidemia, diabetes, or hypercoagulable disorders, and no oral contraceptive or anabolic hormone use.

• Extensive evaluation did not identify an alternative cause; infectious testing was negative, most reported laboratory results were within normal limits, and imaging was unremarkable.

• No pharmacologic treatment was given. After advice to increase oral hydration and temporarily avoid strenuous exercise, retinal findings improved at 1 month and resolved by 10 months.

• The authors proposed that exercise-associated dehydration might increase transient hyperviscosity and erythrocyte aggregability and reduce blood flow, but the report did not objectively confirm dehydration or hyperviscosity.

• The authors characterized the report as a single case that cannot establish causality. The RCOphth guideline states that non-ischemic CRVO may resolve without complications and that high-quality evidence does not support routine anticoagulation or antiplatelet therapy.

Clinical Implications

The case authors advised increased oral hydration and a temporary pause in strenuous exercise, followed by clinical observation; the patient later resumed exercise while mindful of hydration and reported no recurrence. For CRVO assessment, the cited AAO guidance describes OCT and angiography as indicated and surveillance for neovascular complications; treatment options such as anti-VEGF therapy or intravitreal corticosteroids apply to macular edema, which was absent in this case.

Conclusion

This case documents spontaneous resolution of mild perfused CRVO in a young adult after exercise, with relative dehydration proposed—but not demonstrated—as a contributing factor. It cannot determine whether exercise or dehydration caused the occlusion.

Related Resources & Content

1. Zhu AY et al., Digital Journal of Clinical and Retinal Ophthalmology, year not provided — Dehydration during exercise may contribute to CRVO

2. American Academy of Ophthalmology, Preferred Practice Pattern® Guidelines: Ophthalmology, 2025 — Retinal Vein Occlusions Preferred Practice Pattern

3. Retinal Physician, 2026 — What RVO May Reveal About Systemic Health

4. Endocrine Reviews — Carbohydrate Ingestion on Exercise Metabolism and Physical Performance

5. MDSpire News — Vitamin D Deficiency May Drive RVO

6. new retinal physician — A "Workout" for Central Serous Chorioretinopathy

7. American Academy of Ophthalmology Retinal Vein Occlusions Preferred Practice Pattern

8. Open Access Case Report

9. What RVO May Reveal About Systemic Health

10. Ranibizumab for Macular Edema following Central Retinal Vein Occlusion: Six-Month Primary End Point Results of a Phase III Study - ScienceDirect