Bilateral central retinal artery occlusion in Wegener's granulomatosis and alpha1 antitrypsin deficiency

Visual loss occurs in up to 8% of patients with Wegener's granulomatosis (WG) during the disease lifetime,1 although only a small proportion of these cases are the result of central retinal artery occlusion (CRAO). We describe an unusual case of a patient with bilateral CRAO as a presenting feature of WG and α1 antitrypsin (AAT) deficiency. A 58 year old white man presented with sudden painless loss of vision to the right eye. Vision was hand movements in the right eye and 6/6 in the left. Funduscopy revealed an acute right CRAO with macular oedema. There were no signs of uveitis or retinal vasculitis. Management consisted of intravenous acetazolamide (500 mg), ocular massage, and anterior chamber paracentesis. He was subsequently sent home with aspirin …