This previously healthy 8YO boy presented with sudden vision loss in his right eye 10 days earlier. Vision was counting fingers.
Pseudocolor SLO imaging shows diffuse inner retinal whitening, sparing the central macula. OCT scanning shows a somewhat thickened and markedly hyperreflective inner retina. Cardiac 2D Echo and MRA of the head and neck were normal. Anticardiolipin antibodies were elevated, and he was started on oral clopidogrel and aspirin.
Learning Points:
Central retinal artery occlusion (CRAO) in the pediatric population is exceedingly rare and requires an aggressive search for underlying clotting abnormalities. The antiphospholipid antibody syndrome, also known as anticardiolipin antibody syndrome or lupus anticoagulant syndrome, is caused by autoantibodies directed against phospholipid-bound proteins. These predispose patients to venous and arterial thrombi and increase the risk for pregnancy complications and miscarriage. The syndrome is more common in women and in those with other autoimmune disorders, including systemic lupus.
