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Turati, Mauricio MD*; Velez-Montoya, Raul MD; Gonzalez-Mijares, Carmen Cecilia MD; Perez-Montesinos, Adai MD; Quiroz-Mercado, Hugo MD; Garcia-Aguirre, Gerardo MD

Retinal Cases & Brief Reports: April 2009 - Volume 3 - Issue 2 - p 140-143
doi: 10.1097/ICB.0b013e31815e9919
Original Articles

Purpose: To describe bilateral central retinal vein occlusion (CRVO) as a clinical manifestation of obesity–hypoventilation syndrome (pickwickian syndrome).

Method: Case report.

Patient: A 37-year-old Hispanic man with morbid obesity and obstructive sleep apnea who suddenly developed bilateral loss of vision.

Results: Laboratory studies disclosed the following: hematocrit, 81%; body mass index, 55 kg/m2; PaCO2, 52 mmHg; and blood oxygen saturation (SaO2), 54%. Polysomnography demonstrated 45 obstructive apneas and 133 obstructive hypopneas, with abnormal movements of the inferior limbs during sleep.

Discussion: Hypoxia and hypercapnia produce severe erythrocytosis that causes a change in blood viscosity. This may facilitate thrombus formation at the lamina cribrosa of both eyes manifested as bilateral CRVO.

A case of obesity hypoventilation syndrome associated with bilateral central retinal vein occlusion is reported. Diagnosis, treatment, and outcome are discussed, as are possible etiologies and related pathologic conditions.

From the *Glaucoma Department and the †Retina Department, Asociación para Evitar la Ceguera en México, México City, México.

Reprint requests: Raul Velez-Montoya, Vicente García Torres Number 46, San Lucas Coyoacan, Mexico DF 04060; e-mail:

© 2009 Ophthalmic Communications Society, Inc.