a r c h s o c e s p o f t a l m o l .

2 0 1 3;8 8(5):189–192

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ESPAÑOLA DE OFTALMOLOGÍA

www.elsevier.es/oftalmologia

Short communication

Exudative retinal detachment and primary pulmonary

hypertension夽

J.L. Sánchez-Sevila ∗ , M. Martínez-Rubio, I. López-Meca, J. Belmonte-Martínez

Servicio de Oftalmología, Hospital General Universitario de Alicante, Alicante, Spain

a r t i c l e i n f o a b s t r a c t

Article history: Case report: A 60-year-old woman who was seen in the emergency department due to sudden
Received 8 April 2011 loss of vision in left eye. The fundoscopy study showed exudative retinal detachment. The
Accepted 8 April 2012 patient referred to dyspnea and peripheral edema of one-year duration during the anamne-
Available online 29 June 2013 sis. The systematic study revealed the existence of pulmonary hypertension, and she was
given diuretic treatment (furosemide). After 48 h the detachment was resolved. Subsequent
Keywords: studies identified a primary pulmonary hypertension.
Pulmonary hypertension Discussion: Exudative retinal detachment can be the first clinical sign of a serious disease
Exudative retinal detachment like primary pulmonary hypertension. The ophthalmologist can be the first to detect this
Primary pulmonary hypertension disease.
Dyspnea © 2011 Sociedad Española de Oftalmología. Published by Elsevier España, S.L. All rights
Furosemide reserved.

Desprendimiento de retina exudativo e hipertensión pulmonar primaria

r e s u m e n

Palabras clave: Caso clínico: Mujer de 60 años que acudió de urgencia por pérdida súbita de visión en ojo
Hipertensión pulmonar izquierdo. El estudio fundoscópico mostró desprendimiento de retina exudativo. En la anam-
Desprendimiento de retina nesis refería disnea de un año de evolución y edemas periféricos. El estudio sistémico reveló
exudativo la existencia de hipertensión pulmonar recibiendo tratamiento diurético (furosemida). El
Hipertensión pulmonar primaria desprendimiento se resolvió a las 48 h. Estudios posteriores determinaron una hipertensión
Disnea pulmonar primaria.
Furosemida Discusión: El desprendimiento de retina exudativo puede ser el primer signo clínico de una
enfermedad grave como la hipertensión pulmonar primaria. El oftalmólogo puede ser el
primero en detectar esta enfermedad.
© 2011 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L. Todos los
derechos reservados.

夽
Please cite this article as: Sánchez-Sevila JL, et al. Desprendimiento de retina exudativo e hipertensión pulmonar primaria. Arch Soc
Esp Oftalmol. 2013;88:189–92.
∗
Corresponding author.
E-mail address: sanchez.se@hotmail.com (J.L. Sánchez-Sevila).

2173-5794/$ – see front matter © 2011 Sociedad Española de Oftalmología. Published by Elsevier España, S.L. All rights reserved.
190 a r c h s o c e s p o f t a l m o l . 2 0 1 3;8 8(5):189–192

Introduction

Exudative retinal detachment can be due to different ocular

and extraocular causes. Primary pulmonary hypertension is
a disease of unknown etiology that can exhibit a diversity
of ophthalmological expressions as the result of diminished
venous flow caused by increased systemic venous pressure.

Case report

Female, 60, who visited the Emergency Service due to blurred

vision in the left eye with a few hours of evolution and without
the relevant symptoms. She did not refer arterial hypertension
history or diabetes mellitus.
Fig. 1 – Exudative retina detachment in the left eye.
The ophthalmic assessment gave a visual acuity of 1 in the
right eye and of 0.1 in the left eye which did not improve with
correction. Under biomicroscopic exploration, the anterior
pole was observed to be normal, the same as the right eye ocu-
lar fundus. However, the left eye exhibited retina detachment
in the macular area and temporal retinal area (Fig. 1) compati-
ble with serous detachment. After 24–36 h of the blurred vision
onset, fluorescein angiography and optic coherence tomogra-
phy (OCT, Stratus Carl Zeiss) were taken. The angiography
showed contrast aggregation in the perimacular area of the
left eye which was more evident in late phases (Fig. 2). The
OCT in the right eye was normal, while the left eye exhibited
neurosensory detachment at the macular level with subfoveal
liquid and intraretinal edema (Fig. 3). After performing a new
anamnesis, the patient referred dyspnea when carrying out
medium efforts as well as lower limb edema under one year
of evolution. Accordingly, the cardiology and pneumology ser-
vices were consulted. A systemic study revealed the existence
of pulmonary hypertension, whereupon treatment was estab-
lished with furosemide (approximately 48 h after the onset of
diminished vision). The retina detachment resolved entirely
48 h after beginning the diuretic treatment (Figs. 4 and 5).
After completing the study, it was concluded that the con- Fig. 2 – Left eye fluorescein angiography with aggregation
dition was primary pulmonary hypertension and vasodilating of perimacular contrast in late phases.
therapy was established. Three months after the episode, the

Fig. 3 – Left eye optic coherence tomography with neurosensory detachment at the macular level and intraretinal edema.
 a r c h s o c e s p o f t a l m o l . 2 0 1 3;8 8(5):189–192 191

Fig. 4 – Complete resolution of the exudative detachment in the left eye 48 h after beginning treatment.

Fig. 5 – Left eye optic coherence tomography 48 h after beginning treatment showing the resolution of the detachment at the
macular level and of the intraretinal edema.

visual acuity in the left eye is of 0.9 and the patient remains
stable, in follow-up by pneumology.
Discussion
Primary pulmonary hypertension is a disease of unknown
etiology characterized by an increase of pulmonary pressure
above 25 mmHg at rest and of 30 mmHg while exercising due
to vasoconstriction of the pulmonary vascular Tree.1,2
Predisposing genetic factors associated to familial cases
with dominant autosomic inheritance has been identified.3–5
In what concerns pathogeny, histological and functional
alterations of endothelial cells of pulmonary blood vessels
have been identified.1
Pulmonary hypertension gives rise to right side cardiac
insufficiency, increase of systemic, orbitary and episcleral
venous pressure with outgoing venous flow reduction, pro-
ducing ocular complications.3
Said ocular expressions include dilatation of the conjuncti-
val and episcleral veins,2 central retina vein occlusion, foveal
effusion with choroidal detachment, intraocular pressure
increase (open angle secondary glaucoma) and exudative reti-
nal detachment.2,3 In addition, cases with subacute myopia
and exophthalmos have been described.5
Exudative detachment arises due to the inability of the
retinal pigment epithelium to pump the excess liquid which
accumulates in the subretinal space due to increased hydro-
static pressure in the choriocapillary.3
Therapeutic options are based on vasodilating therapy,
support therapy and pulmonary transplant as the last
resource.1 Diuretics have a beneficial effect on patients with
pulmonary hypertension, particularly in those with right ven-
tricle failure and systemic venous congestion as in the patient
of this report.
The significance of this case resides in the role of the oph-
thalmologist to suspect major systemic diseases on the basis
of ocular signs.
192 a r c h s o c e s p o f t a l m o l . 2 0 1 3;8 8(5):189–192

3. Senthil S, Kaur B, Jalali S, Garudadri C. Secondary open-angle

Conflict of interests glaucoma and central retinal vein occlusion in a patient with
primary pulmonary hypertension. Ophtalmic Surg Lasers
No conflict of interest has been declared by the authors. Imaging. 2009;40:50–3.
4. Saran BR, Brucker AJ, Bandello F, Verougstraete C. Familial
primary pulmonary hypertension and associated ocular
references
findings. Retina. 2001;21:34–9.
5. Paire V, Weber M, Salama B, Agla EK, Closs-Prophète F,
Banchereau M. Hypertension artèrielle pulmonaire primitive
1. Crespo Martínez C, Morales León V, Alonso Ramos H, Alonso familial rèvélée par l’association bilaterale chémosis,
Ortiz B, Molero Gómez R. Hipertensión pulmonar primaria y su myopisation et exophtalmie. J Fr Ophtalmol. 2006;29:e27.
tratamiento. Farm Hosp. 2004;28:48–55.
2. Offret H, Labetoulle M, Offret O. Manifestations oculaires
de l’hypertension primitive de l’artère pulmonaire. J Fr
Ophtalmol. 2009;32:56e1–7e.