Pediatric Central Retinal Artery Occlusion in a Patient With Elevated Lipoprotein (A) and Factor VIII Levels

The purpose of this manuscript is to report a rare case of pediatric central retinal artery occlusion (CRAO) in the setting of atypical hypercoagulable tests. An 11-year-old female presented to the emergency department with painless, visual changes in the left eye. Ophthalmological examination was remarkable for a central area of retinal ischemia and edema with sparing along the distribution of the cilioretinal artery along with a cherry red spot, all of which were consistent with a CRAO. Neuroimaging and infectious disease work-up were unremarkable. Hematological labs demonstrated elevated lipoprotein (a) and factor VIII activity levels. CRAOs generally occur in the adult population in the setting of cardiovascular risk factors and are uncommon in the pediatric age group. In such a demographic, additional investigation including hypercoagulable work-up is warranted. Elevated lipoprotein (a) is thought to be an independent risk factor for atherosclerosis while factor VIII levels can correlate with thromboemboli in the venous vasculature. Becoming aware of such risk factors can help guide the clinician with the diagnostic approach and management when presented with a similar pediatric case.