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Case Reports in Ophthalmological Medicine
Volume 2016, Article ID 8162687, 4 pages
Case Report

Malignant Hypertensive Retinopathy in an Infant with Mid-Aortic Occlusion

1Department of Ophthalmology, Save Sight Institute, Sydney, NSW, Australia
2Sydney Medical School, University of Sydney, Sydney, NSW, Australia
3Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, NSW, Australia
4The Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, NSW, Australia

Received 18 July 2016; Accepted 5 September 2016

Academic Editor: Stephen G. Schwartz

Copyright © 2016 Lawrence J. Oh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. Case report describing an eight-month-old infant presenting with intermittent esotropia and irritability who was found to have malignant (grade 4) hypertensive retinopathy and mid-aortic syndrome. Methods. Visual acuity was 6/140 in the right eye and not recordable in the left eye. Blood pressure was as high as 230/120 mmHg. Fundoscopy revealed bilateral optic disc swelling, macular stars, and serous retinal detachment in the left eye, findings that are consistent with malignant (grade 4) hypertensive retinopathy. CT abdominal angiogram revealed a severe mid-aortic syndrome with occlusion of the abdominal aorta at T12. Results. The patient was treated with medical management of his hypertension, improving the subretinal exudate. Binocular visual acuity improved to 6/9.5 over 9 months. There was a persistent left relative afferent pupillary defect and moderate left esotropia. Conclusion. This is the first reported case of malignant hypertensive retinopathy in an infant with concomitant mid-aortic occlusion. The authors emphasize the need for an ophthalmological and pediatric examination in a child presenting with intermittent squint and irritability. The esotropia was found to be a false localizing sign of raised intracranial pressure secondary to the severe mid-aortic syndrome.