Unilateral central retinal artery occlusion triggered by trauma as initial presentation of occult systemic lupus erythematosus: a case report

This report describes a rare case of unilateral central retinal artery occlusion (CRAO) triggered by mild head trauma, which presented as the primary manifestation of occult systemic lupus erythematosus (SLE) complicated with anti-phospholipid syndrome (APS). A 55-year-old woman presented with sudden no light perception (NLP) in her right eye 20 h after mild head trauma. The diagnosis of CRAO was initially confirmed via comprehensive multimodal ocular imaging. Etiologic laboratory workup revealed positive antinuclear antibodies (ANA), anti-β2-glycoprotein I (anti-β2-GPI), and lupus anticoagulant, consistent with SLE and APS. Despite multidisciplinary immunosuppressive and anticoagulant therapy alleviated systemic symptoms and retinal edema, the visual acuity of the affected eye was left with NLP. Minor trauma may trigger retinal arterial thrombosis in patients with SLE/APS, for whom trauma prevention is essential. This case highlights the necessity of routine autoimmune and coagulation screening for CRAO patients without traditional cardiovascular risk factors, to enable early systemic intervention and prevent catastrophic systemic thromboembolic events.