A 46-year-old woman with bilateral white retinal vessels

Abstract

An asymptomatic 46-year-old woman was incidentally found on routine examination to have bilateral creamy white tortuous retinal vessels with preserved visual acuity. Multimodal imaging, including optical coherence tomography, optical coherence tomography–angiography, and fluorescein angiography, demonstrated hyperreflective dilated retinal vessels with normal retinal perfusion and no evidence of ischemia. In the setting of markedly elevated triglyceride levels and recurrent pancreatitis, the characteristic retinal vascular appearance supported a diagnosis of lipemia retinalis in the context of chylomicronemia syndrome. No ocular treatment was required and management focused on systemic metabolic control through dietary modification, lifestyle changes, and lipid-lowering therapy, resulting in resolution of the anomalous retinal vasculature. This case illustrates lipemia retinalis as a retinal manifestation within the broader spectrum of chylomicronemia syndrome and underscores the importance of recognizing these characteristic vascular findings as a marker of significant systemic lipid dysregulation requiring ongoing multidisciplinary management.