Lipemic Aqueous Humor in Hyperlipidemia and Diabetes Mellitus: A Case Report

Lipemic aqueous humor is a rare ocular condition characterized by a milky appearance in the anterior chamber, primarily associated with hyperlipidemia and poorly controlled diabetes. This case highlights the diagnostic challenges and management of lipemic aqueous humor, emphasizing the need for differentiation from other etiologies such as infectious endophthalmitis.

A 26-year-old woman with type 1 diabetes and hyperlipidemia presented with unilateral vision loss and ocular redness. Examination revealed visual acuity of 20/400, conjunctival congestion, corneal clouding, and milky anterior chamber exudate. Laboratory tests showed severe hyperglycemia (fasting glucose 33.79 mmol/L) and hypertriglyceridemia (23.71 mmol/L). Initial management included anterior chamber irrigation and intravitreal antibiotics due to suspected infection. Treatment was augmented with corticosteroids, mydriatics, and systemic control of glucose and lipids. Visual acuity improved to 20/70 by Day 3 and recovered to 20/20 by Day 6, with stability at 1-month follow-up.

This case underscores that lipemic aqueous humor, though rare, should be considered in the differential diagnosis of anterior chamber opacities in patients with metabolic disorders. The disruption of the blood-aqueous barrier, potentially exacerbated by underlying inflammation in the context of hyperlipidemia and diabetes, is key to its pathogenesis. Prompt diagnosis, metabolic control, and targeted anti-inflammatory therapy can lead to excellent visual outcomes, potentially avoiding unnecessary invasive interventions.