Seeing the difference-Painless progressive vision loss in a vasculopath

Area of Science:

• Vascular Medicine
• Ophthalmology
• Nephrology

Background:

• Calciphylaxis is a severe systemic condition characterized by vascular calcification and skin necrosis, often associated with chronic kidney disease.
• Vascular disease significantly increases the risk of systemic complications, including those affecting vision.

Observation:

• An elderly male patient with a history of vascular disease presented with sudden, painless blurred vision and grey scotomas in his only functional eye.
• The patient had nonhealing necrotic leg ulcers, a common manifestation of calciphylaxis.

Findings:

• Ophthalmic examination revealed retinal ischemia, a cotton wool spot, and optic nerve swelling, indicative of acute ocular compromise.
• Temporal artery biopsy and vascular imaging confirmed myxoid degeneration and extensive arterial calcification, consistent with calciphylaxis.

Implications:

• This case underscores the critical need for ophthalmologic evaluation in patients with calciphylaxis, given the risk of vision-threatening complications.
• Early recognition and management of vascular calcification in calciphylaxis may help prevent irreversible vision loss and other systemic sequelae.