Fluorescein angiography of the bulbar conjunctiva in sickle cell disease

The bulbar conjunctivas of 17 controls and sickle cell patients were examined with a slit lamp and photographed. The characteristic appearance of the conjunctival vasculature in clinically significant sickle cell disease was observed in 8 SS patients and one SThal patient. These patients demonstrated an apparent decrease in the number of visible vessels, an increase in granular blood flow, and the presence of isolated venular segments. The latter were not significantly enhanced by the use of topical phenylephrine. Fluorescein angiography of the conjunctiva was performed on all subjects and revealed a basic angiographic sequence common to both controls and sickle cell patients. The only significant difference appeared in the circulation times, which were faster in the anemic patients. There was no evidence found of arteriolar occlusions, abnormal arteriovenous communications, or neovascular proliferations. The dye demonstrated the arterial system of the conjunctiva well, but the heavy extravasation of dye prevented visualization of the superficial venules. An attempt to fill these vessels and their isolated segments by shunting blood with topical epinephrine was unsuccessful. Significant angiographic observations included the finding of a venous thrombus in a patient with sickle cell trait and the demonstration of the nonperfusion and changing character of the isolated venular segments.