This 34YO African American female presented with several days of painless vision loss in her left eye. Vision was 20/30 OD and HM OS with an afferent defect OS. Anterior segments were normal.
There was mild disc edema OD (not shown) and florid disc edema OS with retinal vasculitis predominantly involving the veins.
On fluorescein angiography, the retinal veins in the left eye were diffusely stained.
On further review of systems, she had a new skin rash on her right forearm, but was otherwise asymptomatic. Testing revealed elevated angiotensin-converting enzyme and lysozyme levels, and a chest X-ray showed bilateral perihilar fullness.
With a working diagnosis of sarcoidosis, she is currently being managed with oral steroids and has been evaluated by both rheumatology and pulmonology.
While her retinal vasculitis has responded well to treatment, her vision remains HM three weeks later.
Learning Points:
Frosted branch angiitis is a retinal vasculitis that gets its name due to the involved vessels resembling the branches of a tree that are “frosted” with snow. Although these findings may be isolated, they are often considered a phenotype found in a multitude of inflammatory conditions, most commonly CMV retinitis.
The inflammation is usually highly responsive to steroids, and the visual prognosis is generally good, although some may develop secondary neovascularization in the anterior and posterior segments due to widespread ischemia.
