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Case Reports
. 2021 Feb 5;14(2):e239954.
doi: 10.1136/bcr-2020-239954.

Sudden onset peripheral visual deficit secondary to retinal artery spasm in Raynaud's phenomenon

Yousuf Ansari  1   2 , Aditya Uday Kale  3 , Mohammad O Tallouzi  2   4 , Avinash Manna  3
Affiliations
Case Reports

Sudden onset peripheral visual deficit secondary to retinal artery spasm in Raynaud's phenomenon

Yousuf Ansari et al. BMJ Case Rep. .

Abstract

A 32-year-old doctor, who has a medical history of primary Raynaud's disease and previous scotomas, presented to eye clinic with sudden onset blurring of vision (infero-nasally) with no other associated symptoms. The patient had good visual acuity bilaterally (6/6) and no anterior chamber activity or conjunctival hyperaemia. Findings consistent with a nerve fibre layer infarct were noted in the right eye, with unremarkable examination of the left eye. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) images were obtained, which showed an area of capillary shut down in keeping with a nerve fibre layer lesion. Previous literature pertaining to similar symptoms is sparse with symptoms such as migraines, epilepsy and visual loss being stated. This case provides further evidence of Raynaud's associated retinal artery spasm, with complete resolution at 4 weeks. We also demonstrate the accessibility of OCT and more importantly OCTA for investigation of sudden onset visual deficit.

Keywords: ophthalmology; retina; rheumatology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
OCT panel showing images taken at presentation (A) and at 4 weeks (B). Complete resolution of the lesion in scan A (indicated by the arrowhead) is seen at 4 weeks in scan B. The right hand panel of scan A also demonstrates RNFL thickening correlating with the en face view. OCTA scan at presentation (C) showing an area of focal capillary shut down consistent with retinal vasospasm (indicated by green arrowhead). OCTA scan at follow-up (D) shows recovery of this focal vessel shut down indicating restoration of blood flow. OCT, optical coherence tomography; OCTA, optical coherence tomography angiography; RNFL, Retinal nerve fibre layer.
Figure 2
Figure 2
OCT scan from the patient’s first presentation showing localised retinal oedema due to capillary shut down. The red area indicates increased retinal thickness signifying oedema. OCT, optical coherence tomography.
See this image and copyright information in PMC

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