When pancytopenia meets the retina: Bilateral central retinal vein occlusion in idiopathic aplastic anemia

Bilateral central retinal vein occlusion (CRVO) is an uncommon condition that often results from systemic causes, including hematologic neoplasms, hyper viscosity states, and thrombophilia. Bilateral CRVO as a complication of idiopathic aplastic anemia is exceedingly rare. We present a case of a 50-year-old female with acute painless bilateral visual loss occurring over the past five days, with a background history of generalized weakness and intermittent low-grade fever over a period of one month. Ocular examination showed bilateral diffuse flame-shaped hemorrhage with optic disc swelling in both eyes. This finding was suggestive of bilateral CRVO without venous dilatation and tortuosity, which would have been expected in hyper viscosity. In view of the rarity of bilateral CRVO, further systemic workup was conducted, which included pancytopenia with hypocellular bone marrow suggestive of idiopathic aplastic anemia. Testing for hyper viscosity, autoimmune profile, and thrombophilia tests was negative.