Some years ago, we recorded an unusual appearance of conjunctival capillaries associated with lipemia retinalis in a diabetic patient.1 Biomicroscopic examination revealed fatty ensheathment of the affected capillaries and small veins, located in the inter-palpebral strip of the bulbar conjunctiva. Histopathologic study of a snip biopsy specimen of the affected area revealed large distended cells projecting into the lumen of these vessels and causing partial occlusion and hemostasis proximal to the involved sites.
Both Sudan black and oil red O stain methods confirmed that the distended foamy cells had a high fat content. The exact derivation of these phagocytic cells displaying transmural lipid imbibition remains unknown, but they could be either wandering tissue sub-intimal macrophages or intimal cells.
Lipemia retinalis is not a common condition. Indeed, we know some ophthalmologists who have never even seen this disorder. Often of evanescent nature, in our case the resolution was tardy, lasting
English FP, Harrison M. Diabetic Retinopathy Following Lipid Disease of the Capillary Endothelium. Arch Ophthalmol. 1996;114(1):106-107. doi:10.1001/archopht.1996.01100130102029