Retinal artery occlusion as a probable idiosyncratic reaction to topical minoxidil: a case report

Abstract Background Minoxidil hair formulation is commonly used for the treatment of male or female androgenic alopecia. This over-the-counter product is considered safe, but should be used with caution. Ocular side effects following topical minoxidil use are rarely reported. In this paper, we report a rare case of inferior hemiretinal artery occlusion possibly caused by topical 5% minoxidil treatment. Case description A 21-year-old Asian Indian male presented to the retina clinic with sudden onset blurring of vision and superior visual field loss in the right eye since morning. He was diagnosed with androgenic alopecia and was on treatment with topical 5% minoxidil spray twice a day for the last 3 years. On examination, his corrected distance visual acuity was 6/6, N6 in both eyes. Anterior segment examination and intraocular pressure in both eyes and left eye fundus were within normal limits. Right eye fundus examination showed features suggestive of inferior hemiretinal artery occlusion, which were confirmed on fluorescein angiography and optical coherence tomography. A detailed systemic evaluation and investigations (blood pressure, random blood sugar, hematological and coagulation profile, serum homocysteine level, Mantoux test, chest x-ray, cardiac two-dimensional echography, thyroid function test, and immunological profile) did not detect any abnormalities. The ocular condition and its visual prognosis were explained to the patient, and he was asked to review after 4 weeks. Conclusion Though there is no definite cause–outcome relationship between topical minoxidil use and retinal artery occlusion development, this possibility should be kept in mind when observing retinal vascular occlusion cases with concurrent use of topical minoxidil.

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Imaging Methods in Retinal Artery Occlusion

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0189 ◽

2020 ◽

pp. 13-17

Keyword(s):

Imaging Techniques ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Sudden Onset ◽

Diagnosis And Treatment ◽

Fundus Fluorescein Angiography ◽

Imaging Methods ◽

Invasive Method ◽

Retinal Microcirculation ◽

Retinal Artery

Advances in ophthalmic imaging methods shed light on the management of retinal artery occlusion (RAO). RAT is an ocular emergency that can cause painless, sudden onset, unilateral vision, or loss of visual field. RAO requires early diagnosis and treatment. Fundus fluorescein angiography (FFA), which can be used in diagnosis and follow-up, is an invasive method requiring intravenous dye application which can cause side effects. In recent years, optical coherence tomography angiography (OCTA) has become widely available as an alternative to FFA in various ophthalmologic diseases. OCTA is a new type of angiography used for fundus imaging. It is a non-invasive method for measuring and quantifying the retinal microcirculation without the use of dyes. Many other imaging modalities used in ophthalmology clinics have been used in many areas of diagnosis and treatment of RAO patients. This review deals with the results of different imaging techniques in patients with RAO.

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OCT based interpretation of the optic nerve head anatomy in young adults with retinal vascular occlusions and ischemic optic neuropathy

European Journal of Ophthalmology ◽

10.1177/1120672120957591 ◽

2020 ◽

pp. 112067212095759

Author(s):

Amy Dai ◽

Lasse Malmqvist ◽

Simon P Rothenbuehler ◽

Steffen Hamann

Keyword(s):

Young Adults ◽

Optic Nerve ◽

Optic Nerve Head ◽

Vascular Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Ischemic Optic Neuropathy ◽

Vein Occlusion ◽

Retinal Vascular Occlusion ◽

Retinal Artery

Purpose: To examine optic nerve head (ONH) anatomy in young adults with central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO) or nonarteritic anterior ischemic optic neuropathy (NA-AION) in order to look for associated, potentially predisposing anomalies. Methods: Cross-sectional study including 54 patients (ages 16–50 years) diagnosed from 2009 to 2018 with CRVO, BRVO, CRAO, BRAO, or NA-AION. Using Optical Coherence Tomography the presence of optic disc drusen (ODD), prelaminar hyperreflective lines and peripapillary hyperreflective ovoid mass-like structures (PHOMS), and determination of scleral canal size, retinal nerve fiber layer thickness (RNFLT) and macular ganglion cell layer thickness (GCLT) was obtained. Data for retinal vascular occlusion patients were grouped and analyzed together. Results: ODD were found in 13% of all patients, 2% of retinal vascular occlusion patients and 67% of NA-AION patients ( p < 0.0001). Prelaminar hyperreflective lines were found in 35% of all patients, 24% of retinal vascular occlusion patients and 89% of NA-AION patients ( p = 0.0005). PHOMS were found in 20% of all patients, 13% of retinal vascular occlusion patients and 56% of NA-AION patients ( p = 0.012). RNFLT was decreased in ODD patients compared to patients without ODD ( p = 0.01). Scleral canal diameter and GCLT was not correlated with ODD, prelaminar hyperreflective lines or PHOMS. Conclusion: ODD, prelaminar hyperreflective lines and PHOMS were more frequent in NA-AION patients compared to retinal vascular occlusion patients. The prevalence of ODD in retinal vascular occlusion patients was similar to the reported prevalence in the general population.

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Sudden onset blindness in sickle cell disease due to retinal artery occlusion

Pediatric Blood & Cancer ◽

10.1002/pbc.21152 ◽

2008 ◽

Vol 50 (3) ◽

pp. 624-627 ◽

Cited By ~ 16

Author(s):

Robert I. Liem ◽

Diane M. Calamaras ◽

Manpreet S. Chhabra ◽

Beatrice Files ◽

Caterina P. Minniti ◽

...

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Sudden Onset ◽

Cell Disease ◽

Retinal Artery

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Undiagnosed Patent Foramen Ovale Presenting as Retinal Artery Occlusion—An Emerging Association

Journal of Ophthalmology ◽

10.1155/2009/248269 ◽

2009 ◽

Vol 2009 ◽

pp. 1-2 ◽

Cited By ~ 2

Author(s):

Hiten G. Sheth ◽

Tania Laverde-Konig ◽

Jyoti Raina

Keyword(s):

Patent Foramen Ovale ◽

Transoesophageal Echocardiography ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Sudden Onset ◽

Healthcare Personnel ◽

Foramen Ovale ◽

Management Options ◽

Retinal Artery ◽

Fundus Photographs

Purpose. To report patent foramen ovale (PFO) as the cause of retinal artery occlusion in a young and previously fit male and discuss the appropriate medical and surgical management options.Methods. Interventional case report with serial fundus photographs of an 18-year-old male presenting to the eye casualty with sudden onset left visual loss.Results. Visual acuities were 6/24 left and 6/4 right with a left afferent pupillary defect. Slitlamp examination confirmed a left hemiretinal artery occlusion and subsequent cardiology review with transoesophageal echocardiography revealed patent foramen ovale which was closed surgically.Conclusions. PFO is not uncommon and is often covert but predisposes individuals to embolic events. These events may be ophthalmic with visual sequelae and so ophthalmologists, physicians, and other healthcare personnel should be aware of this important and emerging association.

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Periarteriolar-Sparing Retinal Edema in Acute Central Retinal Artery Occlusion

Case Reports in Ophthalmology ◽

10.1159/000442175 ◽

2015 ◽

Vol 6 (3) ◽

pp. 390-393 ◽

Cited By ~ 1

Author(s):

Yoshifumi Ikeda ◽

Ichiya Sano ◽

Etsuko Fujihara ◽

Masaki Tanito

Keyword(s):

Optic Disc ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Sudden Onset ◽

Central Retinal Artery ◽

Systemic Hypertension ◽

Cotton Wool ◽

Retinal Edema ◽

Retinal Artery

A 56-year-old man was referred to our hospital about 48 h after sudden onset of painless central visual loss in his right eye (OD) on a winter morning. He had a more than 25-year history of systemic hypertension and smoking. Funduscopic observation showed striated retinal whitening in the macular region, faint cotton-wool patches around the optic disc, and segmental narrowing of the retinal arteries near the optic disc edge. Based on the pattern of onset and fundus findings, he was diagnosed with vasospastic acute central retinal artery occlusion OD, and a venous drip injection of prostaglandin E1 was started immediately. Optical coherence tomography showed bands of high and low density in the inner retina arranged alternately in the edematous area; the bands corresponded to edematous and nonedematous areas, respectively, and geographically to venules and arterioles, respectively. The best-corrected visual acuity of 0.03 at referral improved to 0.5, and the striated retinal edema and most cotton-wool patches resolved 1 month after onset. The oxygen pressure gradient in the capillary networks due to differences in the distance from the arterioles may be the mechanism of this unique periarteriolar-sparing retinal edema pattern.

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A rare case having hemi-retinal artery occlusion in one eye and hemi-retinal vein occlusion in the other: Diverse manifestations of retinal vascular occlusion

Indian Journal of Ophthalmology ◽

10.4103/ijo.ijo_987_18 ◽

2019 ◽

Vol 67 (2) ◽

pp. 273

Author(s):

Pulak Agarwal ◽

Vinod Agarwal ◽

Shorya Azad

Keyword(s):

Retinal Vein Occlusion ◽

Rare Case ◽

Vascular Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

The Other ◽

Vein Occlusion ◽

Retinal Vascular Occlusion ◽

Retinal Artery

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The association of aldosterone with papillophlebitis and retinal artery occlusion: A case report

European Journal of Ophthalmology ◽

10.1177/1120672121991399 ◽

2021 ◽

pp. 112067212199139

Author(s):

Che-Yuan Kuo ◽

Po-Kang Lin

Keyword(s):

Visual Acuity ◽

Intravitreal Injection ◽

Retinal Artery Occlusion ◽

Pulse Therapy ◽

Artery Occlusion ◽

Steroid Pulse Therapy ◽

Steroid Pulse ◽

Retinal Vascular Occlusion ◽

Retinal Artery ◽

The Right

Purpose: To explore the association between elevated blood aldosterone levels and papillophlebitis and retinal artery occlusion in a young, healthy woman. Case description: A 19-year-old woman with an unremarkable medical history presented with sudden-onset visual loss in the right eye, which lasted for 10 hours. Fundus examination revealed retinal whitening, splinter hemorrhages, disc swelling, and tortuous vessels in the right eye. Optical coherence tomography revealed inner retinal thickening. Fluorescein angiography demonstrated a delayed arteriovenous transit time and delayed filling of the cilioretinal artery circulation. Further workup showed a high aldosterone level and aldosterone-to-renin ratio. The patient was treated with steroid pulse therapy and combined intravitreal injection of dexamethasone implant and aflibercept. Visual acuity was recovered from count finger at initial presentation to 6/15 on the fifth day. For over 2 months, the fundal manifestations gradually subsided. Three months after the episode, her visual acuity further improved to 6/6.7. Conclusion: This report emphasizes the potential role aldosterone plays in the complex disease mechanism of retinal vasculopathy. In addition, steroid pulse therapy is more effective when applied in conjunction with combined intravitreal injection therapy for rescuing impaired vision caused by retinal vascular occlusion.

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Varicella Zoster Meningitis, Optic Neuritis Preceding the Development of Posterior Outer Retinal Necrosis, and Central Retinal Artery Occlusion in a HIV Patient

Case Reports in Medicine ◽

10.1155/2019/4213162 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Manasa Gunturu ◽

Shiva Kumar Gosi ◽

Swetha Kanduri ◽

Vishnu Garla

Keyword(s):

Optic Neuritis ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Sudden Onset ◽

Blurred Vision ◽

Cerebral Angiogram ◽

Varicella Zoster ◽

Csf Analysis ◽

Retinal Artery

Varicella-zoster virus (VZV) has been known to cause various eye disorders in both immunocompetent and immunocompromised patients. We present a case of a forty-nine-year-old female patient with acquired immunodeficiency syndrome (AIDS) who presented with headache, fever, and blurred vision. Cerebrospinal fluid (CSF) analysis was consistent with VZV meningitis. Magnetic resonance imaging (MRI) of the brain showed enhancement of the right optic nerve indicative of optic neuritis. She responded well to acyclovir and steroids and discharged on the same. Four weeks after discharge, she presented with sudden onset blindness in the left eye. A cerebral angiogram revealed left retinal artery occlusion and was treated with tissue plasminogen activator (tPA). Funduscopic examination showed patchy areas of necrosis in the periphery which were rapidly progressive, diagnostic of posterior outer retinal necrosis (PORN). She was started on ganciclovir and cidofovir and experienced significant improvement in her visual acuity.

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