Author: Maria João Matias (Portugal)
Co-authors: Jeniffer Jesus, Vítor Miranda, Catarina Pestana Aguiar, João Chibante-Pedro, Raquel Soares
Purpose
To describe a case of three episodes of branch retinal arterial occlusion (BRAO) in a healthy female patient, taking combined oral contraceptive (drospirenone/ethinyl estradiol).
Setting/Venue
Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
Methods
Clinical Case Report
Results
A 28 year-old woman, with no relevant personal background, taking combined oral contraceptive (drospirenone/ethinyl estradiol) for one year, presented to emergency department complaining of sudden vision loss in the right eye (RE). Ophthalmological examination revealed on fundus examination, a pale retina involving inferior temporal quadrant. Fluorescein angiography confirmed branch retinal artery occlusion (BRAO). Considering these findings, it was requested a systemic assessment, with an overall investigation including carotid artery imaging, cardiac evaluation, vasculitis, hypercoagulable and infectious state screening and cardiac study. Systemic investigations undertaken were within normal limits. Two months later, the patient presented again to emergency department with sudden vision loss of left eye (LE), being diagnosed with LE BRAO, affecting the inferior temporal quadrant. The patient was being followed by internal medicine specialty, and the warning of stopping the birth control pill was considered but the patient chose to continue with the same pill. Four months later, the patient started complaining oh RE blurry vision, being diagnosed with BRAO, involving superior temporal quadrant. Given the history of repeated occlusive arterial phenoms, the patient started acetylsalicylic acid and stopped taking oral contraceptive, being free of new events for more than two years.
Conlusions
Retinal artery occlusion is an ophthalmologic emergency that requires a quick intervention and can lead to irreversible vision loss. Many conditions have been reported to be associated with retinal artery occlusion, being oral contraception a known etiological cause. Oral contraceptives are implicated in atherogenesis, amelioration of the vasoconstrictor sensivity, vascular fragility with endothelial dysfunction, vascular endothelial growth factor (VEGF) stimulation and coagulopathy. The incidence of combined oral contraceptives-related ocular complications is real and should be take into consideration. With this clinical case we highlight the importance of including oral contraceptive pills in the differential diagnosis of acute vision loss, as it can be associated with variable adverse effects on ocular tissues.
Financial Disclosure
No financial relations
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