Central Retinal Vein Occlusion in a Young Healthy Man Following Strenuous Exercise: Multimodal Imaging and Treatment Response.

Central retinal vein occlusion (CRVO) is uncommon in young, otherwise healthy individuals and is often associated with underlying systemic or hematological risk factors. We report a case of a 23-year-old healthy man who presented with sudden painless diminution of vision in the right eye shortly after engaging in strenuous physical exercise involving heavy weightlifting. Best-corrected visual acuity at presentation was 6/18. Fundus examination revealed optic disc edema, dilated and tortuous retinal veins, and widespread intraretinal hemorrhages consistent with non-ischemic CRVO. Optical coherence tomography (OCT) demonstrated significant cystoid macular edema with a central macular thickness of 823 µm and associated subretinal fluid. Comprehensive systemic evaluation, including hematological, metabolic, coagulation, autoimmune, cardiac, and carotid workup, was unremarkable. The patient was treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy, resulting in marked anatomical improvement and visual recovery to 6/9 on follow-up. Although CRVO in young patients is rare and often idiopathic, intense physical exertion may act as a potential precipitating factor through transient hemodynamic changes such as increased venous pressure, Valsalva-like mechanisms, and hemoconcentration. This case highlights the importance of considering recent physical stressors in the clinical history and demonstrates a favorable treatment response with anti-VEGF therapy.