Unilateral CRAO as the presenting clinical sign of systemic lupus erythematosus

PURPOSE: This report describes the case of unilateral central retinal artery occlusion (CRAO) as a patient's presenting clinical sign of systemic lupus erythematosus (SLE). OBSERVATIONS: Though the patient knew of her SLE diagnosis through incidental abnormal lab work, she never pursued treatment because she never exhibited signs of the disease. Despite her asymptomatic course, she presented with a sudden and severe thrombotic event that left her with no light perception in her affected eye. Laboratory work-up was consistent with SLE and anti-phospholipid syndrome (APS). CONCLUSIONS AND IMPORTANCE: This case draws attention to the possibility of CRAO as a presenting sign of SLE, rather than a sequela of active disease. Awareness of this risk may play a factor in future discussions between patients and their rheumatologists when considering initiation of treatment at the time of diagnosis.