A mild perfused central retinal vein occlusion (CRVO) developed in a 38-year-old woman after intense exercise, with relative dehydration suspected as a contributing factor, and resolved without pharmacologic treatment.
Investigators described a patient who experienced 2 episodes of photopsias and blurred vision in both eyes, more pronounced in the left eye, each lasting approximately 1 to 2 hours. She first noticed the symptoms during a 50-minute high-intensity interval training (HIIT) class involving running and weightlifting. She had no personal or family history of glaucoma, hypertension, hyperlipidemia, diabetes, or hypercoagulable disorders and reported no oral contraceptive or anabolic hormone use.
CRVO predominantly affects older adults, with approximately 10% to 15% of cases occurring in patients younger than 50 years. Because of her relatively young age and atypical presentation, the clinical team initiated an extensive diagnostic evaluation and advised increased oral hydration and a temporary pause in strenuous exercise. She was referred to the emergency department for further evaluation and rehydration but declined, opting instead for outpatient assessment.
Clinical assessment included best-corrected visual acuity, intraocular pressure, dilated fundus examination, optical coherence tomography (OCT), and fluorescein angiography (FA). At presentation, visual acuity was 20/20 in both eyes, and intraocular pressure was 13 mmHg in the right eye and 14 mmHg in the left eye. The right fundus was normal, whereas the left eye showed marked venous tortuosity and scattered intraretinal hemorrhage. OCT demonstrated disorganization of the inner and outer retinal layers in the papillomacular bundle of the left eye without macular edema, while FA showed no delayed filling, ischemia, or neovascularization. Researchers diagnosed mild perfused CRVO of the left eye.
The subsequent workup did not identify an alternative cause. Testing for syphilis, HIV, and tuberculosis was negative, and protein C and protein S levels, antithrombin III, thyroid-stimulating hormone, and antinuclear antibodies were within normal limits. Activated partial thromboplastin time was slightly decreased, but the complete blood count was otherwise unremarkable. Imaging showed no acute intraorbital or intracranial pathology, and chest radiography and vascular imaging were also normal.
No pharmacologic treatment was administered. At 1 month, following advice to increase oral hydration and temporarily avoid strenuous exercise, venous tortuosity and intraretinal hemorrhage had improved, while visual acuity remained 20/20. At 10 months, venous tortuosity had completely resolved, with no residual symptoms and visual acuity remaining 20/20. The patient subsequently resumed exercise while remaining mindful of hydration, and her symptoms did not recur. Repeat FA was not performed.
Investigators proposed that exercise-associated dehydration may have increased transient hyperviscosity and erythrocyte aggregability, and reduced bloodflow, potentially contributing to the patient'sretinal venous tortuosity and hemorrhage. The report did not document objective measures confirming dehydration or a transient hyperviscous state. It is limited to a single case and therefore cannot establish a causal relationship between intense exercise, dehydration, and CRVO.
“Excessive physical exertion and dehydration, particularly during the summer months, may be a modifiable risk factor to decrease the incidence of CRVO in young adults,” wrote lead study author Ashley Y. Zhu, BS, of the Israel Englander Department of Ophthalmology at Weill Cornell Medical College, and colleagues.
The authors reported no conflicts of interest. The work was supported by the Foundation for Ophthalmology Research and Education-International (FORE-I).
Source: Digital Journal of Clinical and Retinal Ophthalmology
