This 17YO male presented with bilateral vision loss and pain on eye movements 1 week following a COVID-19 infection. There was no prior ocular or medical history. Vision was 20/70 OD and 20/50 OS.
Color imaging of the right eye shows a large temporal retinal venous malformation. This vessel shows angiographic laminar filling without leakage. The right and left nerves were clinically normal, and the left fundus was normal (not shown).
OCT retinal nerve fiber layer analysis was normal bilaterally. Visual fields show moderate generalized constriction OD and nasal loss OS with a possible vertical cut inferiorly. Subsequent neurologic imaging was consistent with optic neuritis. Additional workup was unremarkable, and neuro-ophthalmic consultation led to the diagnosis of bilateral retrobulbar optic neuritis secondary to COVID-19.
Observation was recommended, and symptoms began to improve within a week. Two months later, all visual symptoms resolved, vision returned to 20/25 OU, and the visual fields normalized.
Learning Points:
Retinal vessels virtually always respect the horizontal meridian. Retinal venous malformations are congenital anomalous vessels that, by definition, cross the horizontal.
Originally described by Gary Brown et al as congenital retinal macrovessels (Arch Ophthalmology 1982;100:1430-1436), these vessels are usually located in the macular region and are virtually always venous.
These lesions are now called retinal venous malformations, since about one-quarter of patients have associated venous anomalies in the brain (Pichi et al, JAMA Ophthalmol 2018;136:372-379).
