Multiple Occlusive Retinal Arteritis in Both Eyes of a Patient with Rheumatoid Arthritis

Abstract

Purpose: To report multiple occlusive retinal arteritis as a complication of rheumatoid arthritis.

Case: A 67-year-old woman developed superotemporal branch retinal artery occlusion in both eyes, together with arterial sheathing and large cotton wool patches around the optic disc, in the course of rheumatoid arthritis with moderate activity.

Observations: Fluorescein angiography disclosed delayed filling of the superotemporal retinal artery in the right eye and no filling of the superotemporal artery in the left eye. In addition, segmental absence of filling was found in peripheral branches of the other major retinal arteries in both eyes. After hyperbaric oxygen therapy and intravenous administration of prostaglandin E1 and urokinase for 2 weeks, there was improvement in her vision.

Conclusion: Multiple occlusive retinal arteritis in rheumatoid arthritis can manifest as retinal artery occlusion. Rheumatoid arthritis should be included in the differential diagnosis of bilateral retinal artery occlusion.

Introduction

The ophthalmic complications of rheumatoid arthritis develop mainly on the ocular surface, and manifest as keratoconjunctivitis sicca, corneal-melting disease, episcleritis, and scleritis.¹ In contrast, retinal and choroidal complications are basically rare in rheumatoid arthritis. Retinal hemorrhage,¹ retinal vasculitis,2, 3 geographic choroiditis,⁴ and subretinal fibrosis⁵ have been reported until now. The author reports on a patient who developed bilateral multiple occlusive retinal arteritis, simulating retinal artery occlusion, in the course of rheumatoid arthritis.