Parafoveal arteriolar obstruction after ocular trauma in a patient with systemic lupus erithematosus

Retinal arterial obstruction after ocular trauma is a rarely described entity which presents a still controversial pathogenesis. However, intravascular leucoembolization in response to activation of complement factor 5 (C5a) has now been hypothesized as a possible cause of arterial embolization after severe trauma. Coincidentally, the pathogenesis of vascular lesions seen in active systemic lupus erithematosus is also related to the activation of the same complement factor.

We present the case of a 32-year-old man with active systemic lupus erithematosus who received a blunt trauma in his right eye and immediate developed severe visual loss.

Ophthalmoscopy of the affected eye revealed a cherry-red spot macula, small hemorrhages and edema of the posterior pole. Fluorescein-angiography showed obstructions and staining of small branches of arterioles in the parafoveal region. After 2 months of follow-up, the ophthalmoscopic picture evolved to optic atrophy and the visual acuity remained severely reduced.

We hypothesize that patients with complement-mediated diseases are predisposed to retinal arteriolar obstruction after ocular trauma.