Anaemic Retinopathy as a Rare Sequela of Gastrointestinal Haemorrhage: A Case Report

Anaemia is defined by a low count of healthy red blood cells, low haemoglobin levels, or both. Anaemic retinopathy is most likely to present in cases of severe anaemia. Although uncommon, anaemic retinopathy may initially be asymptomatic and can progress into a sight-threatening condition. Hereby, the authors present a case report of a 40-year-old male presented to the Outpatient Department with complaints of sudden, painless loss of central field of vision in the Right Eye (RE) for the past three months. He had six episodes of haematemesis and two episodes of melena three months ago. He was a known chronic alcoholic for four years. His Best Corrected Visual Acuity (BCVA) in the RE was 6/36 with Pinhole Not Improving (PH NI); in the Left Eye (LE), the BCVA was 6/6, N6. The anterior segment showed tarsal conjunctival pallor, and fundus examination of both eyes revealed white-centred haemorrhages (Roth spots) with a pre-retinal macular haemorrhage in the RE. Complete Blood Count (CBC) showed haemoglobin of 7.6 g/dL, White Blood Cell (WBC) count of 3,500 cells/cu.mm, and a peripheral blood smear suggestive of microcytic hypochromic anaemia. Endoscopy showed Grade 2 oesophageal varices with severe portal hypertension. The patient was treated with parenteral iron therapy, nutritional supplements, and underwent endoscopic band ligation for oesophageal varices. After one month of follow-up, the patient’s BCVA improved to 6/6 in both eyes, with haemoglobin of 10 g/dL. Fundus examination showed resolution of sub-inner Limiting Membrane (ILM) macular haemorrhage in the RE, along with resolution of Roth spots in both eyes. The present case is unique because retinopathy secondary to acute gastrointestinal bleeding from oesophageal varices has rarely been reported. The combination of haematological and portal hypertensive factors appears to be the underlying mechanism, and prompt management with iron supplementation and endoscopic variceal ligation led to resolution of retinal pathology. This highlights a novel association between systemic management of portal hypertension and ocular outcome.