Abstract
Purpose
To report a case of a hemi-retinal vein occlusion (HRVO) in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Observations
A 32-year-old healthy male presented with a paracentral scotoma, retinal hemorrhages, and dilated and tortuous retinal vessels inferiorly in the right eye. He was diagnosed with HRVO in the setting of recent SARS-CoV-2 infection.
Conclusions and importance
Venous thromboembolic complications and coagulation abnormalities have been widely reported in association with SARS-CoV-2 infection. We highlight this case to raise awareness that a retinal vein occlusion in an otherwise healthy, young patient may be a potential manifestation of the thromboinflammatory state associated with SARS-CoV-2 infection.
1
Introduction
Hemi-retinal vein occlusion (HRVO) is a variant of central retinal vein occlusion (CRVO) with hypercoagulability thought to be a risk factor, especially in younger patients. Abnormal hematologic parameters and an increased risk of venous thromboembolism are common among patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). , We report a case of a young patient with a HRVO in the setting of SARS-CoV-2 infection.
2
Case report
A 32-year-old previously healthy male with fevers, cough, fatigue, and anosmia was diagnosed with SARS-CoV-2 infection with positive reverse transcriptase polymerase chain reaction (RT-PCR) testing from a nasopharyngeal swab. He was referred by his primary care doctor as he reported mild blurriness in his superior visual field in his right eye. The blurring was only present when looking at a light background and had been present for about two weeks. His visual acuity was 20/20 in both eyes and an initial dilated fundus examination was unremarkable. No further diagnostic imaging, including invasive testing such as fluorescein angiography, was performed to limit exposure to other patients and personnel in the clinic given his active infection. Two subsequent RT-PCR tests were positive, followed by two consecutive negative RT-PCR tests and the development of detectable serum IgG antibodies to SARS-CoV-2 about seven weeks after initial symptoms onset. He remained normotensive during and after the time of his illness with SARS-CoV-2.
One month after his initial examination, he reported worsening symptoms with sudden onset paracentral scotoma in his right eye and was evaluated the same day. On examination, his visual acuity remained 20/20 in both eyes. Dilated fundus examination of the right eye showed rare scattered hemorrhages in the inferior hemisphere and dilated and tortuous vessels inferiorly ( Fig. 1 A). Fundus examination of the left eye appeared normal. Fluorescein angiography showed marked delay in filling of the inferior venous circulation ( Fig. 1 B–C) with late staining of those vessels OD ( Fig. 1 D). Optical coherence tomography of the macula showed no evidence of central macular edema OU, but there was mild thickening and increased hyperreflectivity of the outer plexiform layer nasally OD, corresponding to the patient’s scotoma ( Fig. 2 ).
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