OPHTHALMIC ARTERY OCCLUSION AS THE PRESENTING SIGN OF ACQUIRED IMMUNODEFICIENCY SYNDROME

The purpose of this study was to describe a case of severe occlusive vasculitis that led to a diagnosis of AIDS in a previously healthy middle-aged man.

Multimodal imaging including widefield fundus photography, spectral domain optical coherence tomography, and widefield fluorescein angiography was performed.

A healthy 46-year-old man presented with sudden onset vision loss in his left eye with an afferent pupillary defect. His examination revealed signs of retinal vascular disease in both eyes, with an ophthalmic artery occlusion in his affected left eye and a hemiretinal vein occlusion in his asymptomatic right eye. An extensive medical workup was significant for HIV positivity; he was ultimately diagnosed with AIDS, and ocular findings were attributed to an associated occlusive vasculitis. He developed anterior segment neovascularization in the left eye for which he received intravitreal bevacizumab and panretinal photocoagulation. He ultimately required cyclophotocoagulation in the left eye for poorly controlled intraocular pressure in the setting of neovascular glaucoma.

Although HIV is most classically associated with a retinal microangiopathy, testing should be considered in cases of occlusive retinal vasculitis because it is a rare cause of such findings.