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Ophthalmic Artery Occlusion as the Presenting Sign of Acquired Immunodeficiency Syndrome.

PURPOSE
Describe a case of severe occlusive vasculitis that led to a diagnosis of acquired immunodeficiency syndrome (AIDS) in a previously healthy middle-aged man.


METHODS
Multimodal imaging including widefield fundus photography, spectral domain optical coherence tomography (OCT), and widefield fluorescein angiography (FA).


RESULTS
A healthy 46-year-old man presented with sudden onset vision loss in his left eye with an afferent pupillary defect. His exam revealed signs of retinal vascular disease in both eyes, with an ophthalmic artery occlusion in his affected left eye and a hemiretinal vein occlusion in his asymptomatic right eye. An extensive medical workup was significant for human immunodeficiency virus (HIV) positivity; he was ultimately diagnosed with AIDS and ocular findings were attributed to an associated occlusive vasculitis. He developed anterior segment neovascularization in the left eye for which he received intravitreal bevacizumab and panretinal photocoagulation. He ultimately required cyclophotocoagulation in the left eye for poorly controlled intraocular pressure in the setting of neovascular glaucoma.


DISCUSSION
Although HIV is most classically associated with a retinal microangiopathy, testing should be considered in cases of occlusive retinal vasculitis as it is a rare cause of such findings.