Cilioretinal Artery Occlusion in Grade IV Hypertensive Retinopathy in a Young Adult: A Clinical Vignette

Abstract

Cilioretinal artery occlusion (CLRAO) associated with optic disc oedema in the absence of central retinal vein occlusion or an arteritic process is uncommon. We report a 35-year-old man with previously undiagnosed severe hypertension presenting as a hypertensive emergency, with 5 days of painless left-eye visual loss and 1 month of headache. Visual acuity was 20/20 in the right eye and 20/1200 in the left eye. Blood pressure was 190/130 mmHg. Fundus examination showed bilateral hyperaemic disc oedema, cotton wool spots and arteriolar attenuation, with right-eye haemorrhages, consistent with grade IV hypertensive retinopathy; the left eye additionally showed ischaemic whitening in the cilioretinal territory with a cherry-red fovea. Echocardiography showed concentric left ventricular hypertrophy with preserved systolic function; subsequent systemic evaluation did not identify another explanatory vascular or inflammatory disorder. He was admitted for blood pressure control and died of myocardial infarction 6 days later, before the planned ocular imaging with fluorescein angiography and optical coherence tomography could be obtained. The coexistence of CLRAO and grade IV hypertensive retinopathy in a young adult may reflect severe systemic target-organ involvement and should prompt urgent systemic evaluation. Ophthalmologists may be among the first clinicians to recognise an underlying hypertensive emergency.