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Ophthalmic Images
November 12, 2020

A Rare Case of Pulseless Retinopathy

Author Affiliations
  • 1Department of Ophthalmology, Aravind Eye Hospital, Puducherry, India
  • 2Department of Neuro-ophthalmology and Low Vision Services, Aravind Eye Care, Puducherry, India
JAMA Ophthalmol. 2020;138(11):e201404. doi:10.1001/jamaophthalmol.2020.1404

A woman in her 20s with no known systemic illness presented with the complaints of chronic fatigue and gradual, progressive visual acuity loss in both eyes for 3 months. Her best-corrected visual acuity was approximately 20/300 OU. An anterior segment examination had normal results. Her intraocular pressures were 8 mm Hg OU. Gonioscopy showed bilateral open angles. There was no iris or angle neovascularization. A fundus examination (Figure) revealed bilateral disc edema with surrounding arteriovenous anastomoses, tortuous vessels, nerve fiber layer infarcts, and splinter hemorrhages suggestive of ocular ischemic syndrome.1,2 Feeble upper limb pulses with nonrecordable blood pressure levels, normal pulses in the lower limbs,3,4 and elevated inflammatory markers confirmed the diagnosis of Takayasu arteritis. A carotid Doppler examination revealed bilateral carotid artery occlusion.

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