A young patient presented with a 1-week history of unilateral superior visual field deficit in the left eye with a visual acuity of 20/30 with pinhole correction to 20/20, normal IOP, and without an APD. Detailed medical, surgical, family, and social history-taking revealed only patient consumption of caffeinated energy drinks and coffee totaling >1200mg of caffeine per day. Exam disclosed tortuous venous vasculature, inferior disc edema, flame-shaped and dot-blot hemorrhages, and exudation isolated to the inferior hemisphere consistent with a hemispheric retinal vein occlusion (HRVO), and OCT demonstrated inferonasal cystoid macular edema, subretinal fluid, and hemes. Extensive hypercoagulability and systemic inflammatory work-up were normal, in addition to MRI brain and orbits with and without intravenous contrast, echocardiogram, electrocardiogram, and carotid doppler ultrasound. The patient was treated with intravitreal anti-VEGF in the left eye for associated macular edema and, given the negative work-up, the final diagnosis was an energy drink-associated hemi-retinal vein occlusion of the left eye with secondary cystoid macular edema.
Uploaded on: 02/21/2023