Central retinal artery occlusion (reversible in sickle trait with glaucoma

Area of Science:

• Ophthalmology
• Vascular Medicine
• Hematology

Background:

• Central retinal artery occlusion (CRAO) is a rare but serious condition, often associated with cardiovascular risk factors.
• Sickle-trait haemoglobinopathy (HbAS) is a genetic condition that can predispose individuals to vascular complications.
• Acute glaucoma secondary to hyphaema presents a significant challenge in management, particularly in patients with underlying hematologic conditions.

Observation:

• A case of CRAO is presented in an 18-year-old African American woman with known sickle-trait haemoglobinopathy and acute angle-closure glaucoma secondary to hyphaema.
• The CRAO event occurred immediately following the administration of osmotic agents for glaucoma management.
• This temporal association suggests a potential precipitating role for osmotic agents in the development of CRAO in this patient population.

Findings:

• The study highlights a potential iatrogenic complication of osmotic agent use in patients with sickle-trait haemoglobinopathy and acute glaucoma.
• Treatment with anterior chamber paracentesis resulted in the resolution of the CRAO and restoration of good visual function.
• The case demonstrates the potential reversibility of retinal and optic nerve ischemia following CRAO.

Implications:

• Osmotic agents should be used with extreme caution in patients with sickle-cell disease or trait who present with acute glaucoma.
• This case underscores the importance of considering underlying hematologic conditions when managing ocular emergencies.
• Further research is warranted to elucidate the mechanisms by which osmotic agents may precipitate CRAO in susceptible individuals.