Central retinal vein occlusion secondary to severe iron-deficiency anaemia resulting from a plant-based diet and menorrhagia: a case presentation

Abstract

In this case presentation, we present a young vegan patient who developed a CRVO secondary to severe irondeficiency anaemia (IDA) attributable to menstrual losses and limited iron intake. CRVO is a rare complication of IDA. With rising calls for sustainable diets and rising evidence for a plant-based diet, there has been a rise in popularity of such diet forms. While there are ocular benefits from this diet trend, the potential for nutritional deficiencies including iron needs to be monitored especially in susceptible individuals. Iron is essential for retina metabolism and function; however, excess iron contributes to disease states in the eye. Therefore, supplementation needs to be judicious.

COVID-19 lockdown measures induced severe iron-deficiency anaemia resulting in central retinal vein occlusion and amenorrhea

“…CRVO and amenorrhea contributed by IDA were reported in the literature before but this was the first case that was precipitated by COVID-19 related movement restrictions. 3 4 Disruption to diet and hence health is common when countries institute COVID-19 lockdown measures. 10 There are literatures that revealed that lockdown resulted in people purchasing more chips/snacks.…”

“… 19 Many mechanisms were hypothesised to explain thrombosis in IDA including endothelial injury, reactive thrombosis and hypercoagulability. 3 5 6 Factors including diet and lifestyle have also been investigated. 20 Iron is important for metabolism and phototransduction of the retina.…”

“… 2 Cases of iron-deficiency anaemia (IDA)-induced CRVO were previously documented in the literatures. 3 4 The mechanism of thrombosis in IDA may be due to anaemia-induced hypoxia leading to injury of endothelial cells in the retino-choroidal circulation, reactive thrombosis and coagulation dysregulation. 3 5 6 Examples of other life-threatening complications of IDA that were reported include strokes and pulmonary embolism.…”

“… 3 4 The mechanism of thrombosis in IDA may be due to anaemia-induced hypoxia leading to injury of endothelial cells in the retino-choroidal circulation, reactive thrombosis and coagulation dysregulation. 3 5 6 Examples of other life-threatening complications of IDA that were reported include strokes and pulmonary embolism. 7 Furthermore, as many as half of women who have IDA develop amenorrhea.…”

Anaemia induced vision loss

“…Dysregulated coagulation from iron deficiency anaemia can contribute to central retinal vein occlusion and cilioretinal artery occlusion; when present, reactive thrombocytosis and hypoxia induced endothelial injury can also contribute 123…”