Endocrine Abstracts

Case Presentation: 37-year-old woman of South Asian origin was referred from retinopathy screening to our diabetes clinic for evaluation of an unusual finding during her retinal screen. Her retinal blood vessels appeared white in contrast to normal pink to red colour. She was recently diagnosed with type 2 diabetes and with type 1 hyperlipidaemia (T1 HPLA) confirmed by genotype for more than 10 years for which she had suboptimal control with multiple hospitalisations with recurrent pancreatitis. On examination, she had multiple naevi on her skin; rest of the examination was unremarkable. Patient did not report of any visual disturbance and had intact visual acuity. Investigations showed raised total cholesterol (12.5 mmol/l) and triglycerides (57.7 mmol/l). Following evaluation, patient was diagnosed with lipemia retinalis secondary to T1 HPLA. Patient was managed conservatively to reduce cholesterol and triglyceride burden. However, therapies with Orlistat, statin, fibrates and colestyramine failed. Only total dietary prudence and use of MCT oil with glycaemic control optimised with insulin showed some improvements in her lipid profile. Unfortunately, this had led her to become fat soluble vitamin deficient and she was hence treated with appropriate supplementation. Following significant changes, her lipid parameters improved and lipemia retinalis resolved.

Conclusions: Lipemia retinalis is an uncommon incidental finding of T1 HPLA that does not affect vision and acute intervention is not indicated. The management of associated dyslipidemia is challenging with minimal response to conventional treatment. Increased awareness of the condition and specialist management is needed for regular patient monitoring and personalised management.