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Description
A girl aged 16 years presented with sudden loss of vision in the left eye (LE) for 1 day. Visual acuity was 6/6 in the right eye (RE) and perception of light in LE. LE had relative afferent pupillary defect. RE fundus had cotton wool spots (figure 1A). LE fundus showed combined central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) (figure 1B). Her history of alopecia, fever and arthritis for 6 months, bilateral cervical adenopathy, hard palate ulcers, leucopenia (2300/mm3), lymphopenia (621/mm3), positive antinuclear antibody and undetectable serum C4 led us to diagnose systemic lupus erythematosus (SLE). Lupus anticoagulant, anticardiolipin (IgM, IgG) and anti-β2 glycoprotein1 (IgM, IgG) antibodies were negative. She was treated with high-dose corticosteroids and anticoagulant therapy. On follow-up, she was also started on immunosuppressive agent methotrexate as a part of steroid-sparing therapy. Two weeks later, she received intense pan-retinal photocoagulation in LE to prevent neovascular glaucoma. Despite these efforts, she developed vitreous haemorrhage in LE on follow-up. Combined CRAO and CRVO though rare is a severe ocular complication of SLE resulting in irreversible loss of vision. Prompt diagnosis and early management in such a case is important to treat underlying systemic vasculitis and to prevent occurrence of similar episode in the other eye.1 ,2
Learning points
Eye manifestation of systemic lupus erythematosus (SLE) may be sight threatening and can be an indicator of active disease.
Spectrum of retinopathy in SLE varies from few isolated cotton wool spots to the severest form consisting of large retinal vascular occlusions.
Footnotes
Contributors SMP is responsible for managing the patient, idea, critical analysis and editing of manuscript. VSV is responsible for collection of data, writing and editing manuscript. DPM is responsible for managing the patient, editing and analysis of manuscript.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.