Lipemia retinalis


Lipemia retinalis

Description, Causes and Risk Factors:

Lipemia retinalis is a rare and asymptomatic condition which occurs when high levels of triglycerides and chylomicrons (a microscopic particle of triglycerides produced in the intestines during digestion; in the bloodstream they release their fatty acids into the blood) are present in blood. Creamy white appearance of retinal vessels occurs when triglyceride value reaches more than 2000 mg/dL. It is believed that the fundus changes are due to high value of circulating chylomicrons in blood and the effect is due to dispersion of light caused by these chylomicrons. Lipemia retinalis most commonly occurs in familial hyperchylomicronemia, which is an autosomal recessive disorder characterized by lipoprotein lipase or Apo -CII deficiency.

It is believed that the changes in the fundus happen in consequence of the elevated levels of circulating chylomicrons at the retinal vessels, but some authors also defend that only the high levels are not sufficient to cause the lipemic creamy serum. The same idea is defended by other authors who justified that we have some cases with elevated levels of chilomicrons and triglycerides that did not present lipemia retinalis suggesting that changes in hematocrit and in the translucence of the retinal and choroid vessels should be considered.

Causes and risk factors may include:

    Diabetes (especially diabetes mellitus); insulin resistance.

  • Excessive alcohol consumption.

  • Familial hypertriglyceridemia.

  • Fatty liver, cirrhosis, or other liver disease.

  • High sugar diet; poor diet; lack of exercise; obesity.

  • Hypothyroidism (underactive thyroid).

  • Kidney disease or failure; nephrotic syndrome.

  • Pregnancy.

  • Certain medications.

Grades:

The variation of the aspect in the fundus has been graded: grade I (early) - white and creamy aspect of the peripheral retina vessels; grade II (moderate) - the creamy color of the vessels extends towards the optic disc; grade III (marked) - the retina appears with a salmon color and all vessels arteries and veins present a milky aspect. The aspect of grade III has rarely been described.

Symptoms:

Symptoms of lipemia retinalis may include blurred vision, changes in central vision, floating spots, and even some times loss of vision. The first two symptoms are caused by swelling (edema) of the macula, the part of the retina that gives us sharp central vision.Floating spots are droplets of blood from leaky blood vessels growing into the eye's jelly-like center (vitreous body). When these vessels bleed heavily, vision may become completely blocked.Lipemia retinalis can also cause a retinal detachment; this sometimes looks like a billowy curtain.

lipemia retinalis

Diagnosis:

Your ophthalmologist will discuss your symptoms and give you a complete eye exam. He or she will conduct a number of tests in order to understand the type and severity of the disease. The diagnosis of this disease is based on determination of the amount of cholesterol and triglyceride in the plasma. Medical history and family history should be explored. Inquire closely about positive family history, diabetes, gout, hepatic diseases, nephrosis and juvenile coronary heart disease. Early diagnosis and treatment may prevent complications.

Treatment:

Treatment may be based upon factors such as the extent of the elevation, the patient, the underlying cause, and others. Limiting fat and carbohydrates in the patient's diet is a common treatment method. Fish oil, niacin, statins, and fibrates may each be options to be taken. The omega-3 fatty acids found in fish oil have been noted as effective in lowering triglycerides.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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