Lipemia Retinalis

This previously healthy 38YO male was referred for asymptomatic retinal findings. Vision was 20/25 OD and 20/20 OS. Optos color RG imaging shows symmetric, creamy-colored blood vessels bilaterally. Emergent bloodwork showed total cholesterol 1093 mg/dL, triglycerides 9644 mg/dL, and HDL 4 mg/dL. He was immediately referred to his PCP for emergent medical management. He was immediately lost to follow up.

Learning Points:
Lipemia retinalis is a rare retinal manifestation of severe hypertriglyceridemia, characterized by creamy white discoloration of the retinal vasculature. In severe cases, the fundus can turn salmon-colored. Patients are asymptomatic, and vision is normal. However, they are at obvious cardiovascular risk without systemic treatment.

This 47YO female presented with bilateral symmetric creamy colored blood vessels.
Her lipid panel results were: Cholesterol 1039, Triglyceride 821, HDL 7, and LDL too high to measure.

She was immediately referred for medical management of her previously undiagnosed hyperlipidemia.

Learning Points:
Lipemia retinalis is a rare retinal manifestation of severe hypertriglyceridemia, characterized by creamy white discoloration of the retinal vasculature. In severe cases, the fundus can turn salmon-colored.

Patients are asymptomatic and have normal vision. However, they are at obvious cardiovascular risk without systemic treatment.

This 28YO female presented with bilateral symmetric creamy colored blood vessels (only left eye shown). Triglycerides were markedly elevated above 1000.

The vascular appearance normalized 4 months following systemic treatment with a relatively normal triglyceride level of 189.

Learning Points:
Lipemia retinalis is a rare retinal manifestation of severe hypertriglyceridemia, characterized by creamy white discoloration of the retinal vasculature. In severe cases, the fundus can turn salmon-colored.

Patients are asymptomatic, and vision is normal. However, they are at obvious cardiovascular risk without systemic treatment.

This 51YO male’s retinal vasculature turned creamy white from very high triglycerides. His original triglyceride levels were around 4,200 mg/dL.

After 6 months of systemic treatment, his triglyceride levels decreased to 3,100 mg/dL. His blood returned to a normal red color, and his retinal vessels normalized in appearance.

Learning Points:
Lipemia retinalis is a rare retinal manifestation of severe hypertriglyceridemia, characterized by creamy white discoloration of the retinal vasculature. In severe cases, the fundus can turn salmon-colored.

Patients are asymptomatic, and vision is normal. However, they are at obvious cardiovascular risk without systemic treatment.

This 49YO female’s retinal vasculature was initially creamy white from very high triglycerides.

After 8 months of systemic treatment, her triglyceride levels normalized, her blood turned back to its normal red color, and her retinal vessels normalized in appearance.

Learning Points:
Lipemia retinalis is a rare retinal manifestation of severe hypertriglyceridemia, characterized by creamy white discoloration of the retinal vasculature. In severe cases, the fundus can turn salmon-colored.

Patients are asymptomatic, and vision is normal. However, they are at obvious cardiovascular risk without systemic treatment.

This patient’s blood vessels appear milky and possibly occluded, although fluorescein angiography is normal.

A tube of blood drawn from both the patient and a much younger 25YO future founder of Retina Rocks (in his first year of ophthalmology residency) is displayed for comparison. The patient’s blood shows increased lipid content.

Learning Points:
Lipemia retinalis is a rare manifestation of severe hypertriglyceridemia. The blood vessels, and sometimes the entire posterior pole, may appear milky or even salmon-colored.

Patients are asymptomatic, and vision is normal. However, they are at obvious cardiovascular risk without systemic treatment.