Branch retinal artery occlusion as an initial ocular manifestation of severe iron deficiency anemia: A rare case report

Ocular manifestations of anemia include conjunctival pallor, retinal hemorrhages, cotton wool spots, Roth spots, subhyaloid hemorrhage, venous dilatation, disc edema, and anterior ischemic optic neuropathy (AION). Retinal arterial occlusion is a very rare complication of iron deficiency anemia. We, hereby, report such a rare case of branch retinal artery occlusion (BRAO) occurring as a complication of iron deficiency anemia. A 49-year-old female presented with sudden painless diminution of vision in her right eye (RE) for 2 weeks with visual acuity of 20/120 in the affected eye and 20/20 in the left eye. Fundus examination of RE showed disc pallor, arteriolar attenuation, and retinal whitening at macula. Fluorescein angiography study demonstrated delayed filling of superotemporal branch of retinal artery, suggesting BRAO as the cause of vision loss. Thorough evaluation for underlying etiology revealed severe iron deficiency anemia (hemoglobin 3.9 g/dl). Her blood pressure, blood sugar profile, lipid profile, carotid Doppler, echocardiogram, coagulation profile, and immunological workup were all unremarkable. She was treated with packed cell transfusion and oral iron supplementation, and her vision improved to 20/40 at 1-month follow-up. Retinal vascular occlusions can occur rarely in iron deficiency anemia, and therefore anemia should be considered, while evaluation of vascular occlusion – specially in those with associated conjunctival pallor as in our case.