Eye as a Diagnostic Window: A Case of Central Retinal Vein Occlusion Unmasking Pheochromocytoma in a Young Male

Abstract

Purpose: This case report describes central retinal vein occlusion (CRVO) in a young adult as the presenting ocular manifestation of previously undiagnosed pheochromocytoma and highlights the importance of systemic evaluation in atypical retinal vascular occlusion. Case Report: A 29-year-old man with painless diminution of vision and metamorphopsia in the right eye underwent comprehensive ophthalmic examination, optical coherence tomography, fundus fluorescein angiography, blood and urine investigations, abdominal ultrasonography and contrast-enhanced computed tomography. Results: Ocular examination showed non-ischaemic CRVO with centre-involving cystoid macular oedema in the right eye and severe hypertensive retinopathy in both eyes. Systemic examination revealed malignant hypertension, with a blood pressure of 210/140 mmHg, and a history of intermittent palpitations. Abdominal imaging demonstrated a large heterogeneous left adrenal mass, and elevated 24-hour urinary metanephrine excretion confirmed pheochromocytoma. The patient received intravitreal ranibizumab for macular oedema, after which the oedema resolved. Antihypertensive treatment was initiated in consultation with the physician and endocrinologist, and the patient was referred for definitive surgical management with left adrenalectomy. Conclusion: CRVO in a young adult should not be considered an isolated ocular event until systemic causes have been excluded. This case demonstrates that retinal vascular occlusion with severe hypertensive retinopathy may provide the first clinical clue to an occult, potentially life-threatening endocrine disorder.