Acute unilateral anaemic retinopathy secondary to severe iron deficiency from menorrhagia in a young woman

Purpose: To describe acute unilateral anaemic retinopathy associated with severe iron deficiency in a young woman.

Case presentation: A 23-year-old woman presented with acute, painless visual loss in her right eye. Visual acuity was logMAR 1.60 in the right eye, improving to 0.84 with pinhole, and 0.00 in the left. Fundus examination showed optic disc oedema, perifoveal intraretinal haemorrhages and temporal subhyaloid haemorrhages. Blood tests demonstrated severe microcytic anaemia (haemoglobin 78 g/L; mean corpuscular volume 69.8 fL) and depleted iron stores (ferritin 5 µg/L). Platelet count and coagulation studies were normal. She reported menorrhagia and had no clinical features of subarachnoid haemorrhage. Vitamin B12 deficiency was also identified and treated. Following intravenous iron therapy, the retinal haemorrhages almost completely resolved. At one month, right visual acuity had improved to logMAR 0.28; subsequent acuity was logMAR 0.24, with haemoglobin rising to 130 g/L.

Conclusion: Severe iron-deficiency anaemia can cause unilateral retinal haemorrhages and optic disc oedema, even with normal platelet and coagulation results. This presentation may resemble Terson syndrome. Clinicians should assess for intracranial pathology when indicated and identify and correct the underlying anaemia.