A 35-year-old woman with type 2 diabetes mellitus and recurrent pancreatitis attributable to hypertriglyceridemia presented for evaluation of double vision. An external examination revealed a cranial nerve VI palsy deemed secondary to microvascular disease. Although the patient demonstrated normal visual acuity, ophthalmoscopy revealed discoloration of all retinal vessels and a faded, matte appearance of the left and right posterior poles (Figure). Electroretinography findings were consistent with bilateral inner retinal ischemia in demonstrating normal photopic and scotopic a-wave responses, b-wave amplitudes approximately 45% of the minimum value, and borderline-delayed implicit times to a 30-Hz flicker. A laboratory evaluation was remarkable for a total serum cholesterol level of 295 mg/dL (normal range, 120-220 mg/dL; to convert to mmol/L, multiply by 0.0259), and a triglyceride level of more than 2000 mg/dL (normal range, 50-149 mg/dL; to convert to mmol/L, multiply by 0.0113).
Wong S, Shields R, Silva RA. Lipemia Retinalis in a Woman With Hypertriglyceridemia. JAMA Ophthalmol. 2019;137(11):e186224. doi:10.1001/jamaophthalmol.2018.6224
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