From Eye to Echo: Landolfi Sign as a Clue to Diagnosis of Severe Aortic Regurgitation

A 62-year-old male with a history of type II Diabetes Mellitus and recently diagnosed hypertension presented with progressive exertional dyspnea over 6 months, escalating from New York Heart Association Class II to Class IV within the past week. Clinical examination revealed a high-volume collapsing pulse and a wide pulse pressure. Notably, Landolfi’s sign, alternating pupillary constriction and dilation synchronous with the cardiac cycle, was observed and documented via slit-lamp examination. Transthoracic echocardiography confirmed severe aortic regurgitation (AR) with an eccentric regurgitant jet, a regurgitant fraction of 71%, and a reduced left ventricular ejection fraction of 45%. The patient underwent successful aortic valve replacement with a bioprosthetic valve. This case underscores the significance of recognizing rare ocular signs in the clinical assessment of severe AR.