Retinal arterial macroaneurysm causing multilevel retinal hemorrhage

Retinal arterial macroaneurysms are focal dilatations of the retinal arteries that present with varying degrees of retinal hemorrhage or exudation. They are most often associated with hypertension and may masquerade as many other retinal conditions.

A hypertensive 59-year-old man presented to the clinic with a sudden onset of painless vision loss in the left eye. Best-corrected visual acuities were 20/20 in the right eye and counting fingers at 3 feet with eccentric viewing in the left. Dilated fundus examination found a multilevel retinal hemorrhage involving most of the superior arcade and extending into the macular area. A diagnosis of retinal arterial macroaneurysm was given after fluorescein angiography and evaluation by a retina specialist. Hemorrhage resolved without treatment, and visual acuity returned to 20/25 by the 6-month follow-up visit.

Optometrists should be aware of presenting signs and symptoms associated with retinal macroaneurysms as well as the many differentials and possible treatments. Given the high incidence of associated systemic disease, proper knowledge of necessary systemic workup is also critical.