Retinal periphlebitis in multiple sclerosis

The ocular and visual manifestations of multiple sclerosis are varied. The most uncommon is sheathing of the veins, periphlebitis.

A 39-year-old white female presented with primary visual complaints of contrast problems on a computer terminal. The patient was lost to follow up for 4 years, however, upon return a clinical diagnosis of multiple sclerosis was confirmed. Six years after the initial presentation, ophthalmoscopic exam of both eyes revealed marked focal sheathing of the retinal veins in the periphery, and associated hemorrhages in the right eye.

During follow-up, the left eye became further involved developing hemorrhages and a retinal hole, which was treated. The visual consequence of the multiple sclerosis as a result of further exacerbations were bilateral centrocecal scotomas and midly reduced visual acuity.

Multiple sclerosis should be considered in the differential diagnosis of patients with retinal periphlebitis.