P 277
Sudden vision loss in a bulimia caseD. Zeana, A. W. A. Weinberger
Introduction: A 28 old woman was referred to our department for evaluation of a sudden visual loss with a latency of 2 days. The patient reported to feel healthy but looked pale.
Methods: We evaluated visual acuity, intraocular pressure, pupillary reaction, visual field with a Goldman perimeter and funduscopy. Additionally a differential blood analysis was performed.
Results: Visual acuity was 20/200 OD and 20/20 OS. Anterior segment, intraocular pressure and pupillary reactions were unremarkable.
With the Amsler chart a central scotoma without metamorphopsia could be identified. Goldmann perimetry revealed regular visual field outer borders with a scotoma centrally and in the upper field. Funduscopically a foveal intraretinal hemorrhage with ½ disc diameters extension and 2 cotton-wool spots were seen. The left eye presented 2 cotton-wool spots in the inferior temporal arcade and an intraretinal hemorrhage nasally to the optic disc. The differential blood cell count revealed a very low hemoglobin: 47 (N=120-160g/l), hematocrite: 0.15 (N=0.37-0.4l/l), iron: 0.1 (N=11.1.-31 µmol/l), platelets: 90 (N=150-400G/l), serum transferritin: 0.1 (N=45-72%). On direct questioning, the patient admitted having administered herself venous bleeds to reduce her body weight. Thus we referred her to the psychiatry department where she was hospitalized. After initial blood transfusions the red blood cell counts recovered quickly; the macula hemorrhage resolved, visual acuity improved to 20/30.
Discussion: Retinal hemorrhages are a rare initial symptom in bulimic patients. In anemic conditions e.g. after massive hemorhages these might be caused by an acute loss of platelets.
Augenklinik der RWTH Aachen; Pauwelstr. 30, D-52057 Aachen