Multiple sclerosis and occlusive retinal vasculitis: A case series

Abstract

AbstractPurpose: Retinal vascular changes are a common finding in patients with multiple sclerosis (MS). While simple peripheral retinal periphlebitis is by far the most frequent manifestation, a spectrum exists that ranges up to the presence of proliferative retinal vasculitis.Methods: Case series of four patients with occlusive retinal vasculitis.Results: Three patients presented with complaints of visual loss and ocular discomfort: a 26‐year‐old man presented with vitreous inflammation, vitreous haemorrhage, macular edema and papillitis; a 44‐year‐old woman presented with intermediate uveitis and macular edema; and a 25‐year‐old woman presented with granulomatous panuveitis, papillitis and foveolar serous detachment. A fourth patient was addressed because of abnormal eye movements detected during a work‐up for dizziness. Examination revealed bilateral internuclear ophthalmoplegia with adduction lag. He had no visual complaints other than subtle floaters in the left eye. Anterior segment examination showed no signs of inflammation, whereas vitreous snowballs were present. Fluorescein angiography revealed occlusive retinal vasculitis in all patients, resulting in active neovascularization in two patients with vitreous haemorrhage in one of them. All patients required retinal laser photocoagulation. Extensive work‐up revealed multiple sclerosis as the underlying disease in three patients; the remaining patient had already been diagnosed with MS at the time of presentation. Nevertheless, additional work‐up was performed in this patient to exclude other possible causes.Conclusions: Occlusive retinal vasculitis is a rare manifestation in patients with MS and may result in neovascularization, vitreous haemorrhage, retinal detachment and neovascular glaucoma. MS should therefore be considered in the differential diagnosis of ischemic retinal disease. In addition, one should be alert for signs of retinal vasculitis in patients with MS, as it can present with few or no symptoms.