Lipaemia retinalis

Lipaemia retinalis (LR) also spelled as Lipemia retinalis is an eye disease caused by high amounts of triglycerides in the blood (hypertriglyceridemia) or Lipoprotein lipase deficiency (chylomicronemia). In this condition the retinal arteries and veins, and occasionally the entire fundus shows creamy-white to salmon red discoloration.

Lipaemia retinalis
Other namesLipemia retinalis
SpecialtyOphthalmology, Endocrinology
CausesHypertriglyceridemia
Diagnostic methodOphthalmoscopy
TreatmentDiet control, Insulin treatment[1]

Description

Lipaemia retinalis is a retinal disease caused by hypertriglyceridemia or chylomicronemia.[2] Depending on plasma triglyceride level, the retinal arteries, veins or occasionally the entire fundus may show creamy-white to salmon red discoloration.[3] In primary hyperlipidaemia, LR occurs only in patients with increased chylomicron levels.[3]

Lipaemia retinalis occurs commonly with familial hypertriglyceridaemia, and rarely with combined hypertriglyceridaemia.[4] Although serum triglyceride levels above 1000 mg / dL can cause eye symptoms such as xanthoma, xanthelasma and arcus senilis, lipaemia retinalis is most commonly seen when the triglyceride level is above 1500 mg / dL.[5] Changes in fundus are more pronounced when triglyceride levels exceed 2,500 mg / dL.[6]

According to Brunzell and Bierman, lipaemia retinalis occurs in 23% of patients with chylomicronaemia and they says it may be considered as a rare disease only because of lack of routine fundoscopic examination.[4]

Signs and symptoms

In early stage of lipaemia retinalis, creamy-white discoloration of retinal blood vessels occurs and in extreme cases the fundus become salmon red colour.[7] Retinal changes occur in the peripheral vessels gradually progress to entire fundus.[2] Symptoms are caused by an increase in the level of chylomicron in the retinal circulation.[4] Though visual acuity is not affected, electroretinogram amplitude may be decreased.[7]

Since acute increase in triglyceride may be asymptomatic at first, retinal signs of LR are an important clinical sign of hypertriglyceridemia.[8]

Grading

Vinger and Sachs classified lipaemia retinalis into three grades. Early lipaemia retinalis with creamy white discoloration of peripheral retinal vessels is classified as Grade 1.[2] When the discoloration extends towards optic disc, it is graded as Grade 2 and when retina becomes salmon colored it is classified as Grade 3.[2]

Treatment

When the serum triglyceride is under control by proper dietary control and or insulin, the changes in the retina and electroretinogram changes return to normal.[9][5][10]

History

In 1880, Heyl first described Lipaemia retinalis and in 1970 Vinger and Sachs introduced a grading system to describe it's stages.[3]

Other animals

Increase in serum triglyceride can cause lipaemia retinalis in cats also.[11]

References
  1. Martin–Doyle, J. L. C. (22 October 2013). A Synopsis of Ophthalmology: Volume 4. Butterworth-Heinemann. ISBN 978-1-4832-8490-3.
  2. Mishra, Chitaranjan; Tripathy, Koushik (2022), "Lipemia Retinalis", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32310437, retrieved 2022-04-21
  3. D, Chaudhury; R, Meenakshi; R, Ramakrishnan; A, Mitra; S, Raju (2015-10-02). "Lipaemia Retinalis". The Official Scientific Journal of Delhi Ophthalmological Society. 26 (2): 107–110. doi:10.7869/djo.149.
  4. Kempegowda, Punith; Chen, Wentin; Melson, Eka; Leong, Annabelle; Amrelia, Prashant; Syed, Ateeq (1 October 2021). "Incidental finding of lipaemia retinalis on diabetic retinal screening". Endocrinology, Diabetes & Metabolism Case Reports. 2021 (1). doi:10.1530/EDM-21-0051. ISSN 2052-0573. PMC 8558906. PMID 34673543.
  5. Wang, Patrick; Chin, Eric K.; Almeida, David R. P. (17 October 2020). "Lipemia Retinalis in a Patient with Familial Hypertriglyceridemia". Journal of Clinical Imaging Science. 10: 64. doi:10.25259/JCIS_154_2020. ISSN 2156-7514. PMC 7655997. PMID 33194306.
  6. Shinkre, Noopur Deokinandan Nayak; Usgaonkar, Ugam P. S. (June 2019). "Lipemia retinalis in a 27 day old neonate: A case report". Indian Journal of Ophthalmology. 67 (6): 954–957. doi:10.4103/ijo.IJO_1310_18. ISSN 0301-4738. PMC 6552622. PMID 31124530.
  7. Kanski, Jack J.; Bowling, Brad (28 April 2011). Clinical Ophthalmology: A Systematic Approach. Elsevier Health Sciences. ISBN 978-0-7020-4511-0.
  8. "Lipemia Retinalis - EyeWiki". eyewiki.aao.org. Retrieved 2022-04-22.
  9. Ghosh, Sujoy; Collier, Andrew; Varikkara, Mohan; Palmer, Stephen J. (24 October 2011). Fundoscopy Made Easy E-Book. Elsevier Health Sciences. ISBN 978-0-7020-4991-0.
  10. Lu, Chao-Kung; Chen, Shih-Jen; Niu, Dau-Ming; Tsai, Chia-Chen; Lee, Fenq-Lih; Hsu, Wen-Ming (1 June 2005). "Electrophysiological Changes in Lipaemia Retinalis". American Journal of Ophthalmology. 139 (6): 1142–1145. doi:10.1016/j.ajo.2004.12.021. ISSN 0002-9394. PMID 15953465.
  11. Sparkes, Andrew; Caney, Sarah M. A. (20 December 2004). Feline Medicine: Self-Assessment Color Review. CRC Press. ISBN 978-1-84076-579-3.
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