Purtscher retinopathy

Q: What is Purtscher retinopathy? 


Answer: 

Purtscher retinopathy is a sudden decreased vision due to superficial retinal hemorrhages or cotton wool spots encircling the optic nerve. It can occur without any direct injury to the eye and can be seen in various diseases encountered in a critical care setting (see a long list of references below) like traumatic compression of the legs, chest or head, acute pancreatitis, amniotic fluid embolization, preeclampsia, HELLP syndrome and lupus. The exact mechanism is not clear but it appears to be leukoembolization, arterial occlusion, and infarction of the retinal microvascular bed, either due to fat embolization or leukocyte aggregation induced by complement C5a.

#opthalmology
#trauma
#vasculitis
#gastroenterology
#ob-gyn



References:

1. Agrawal A, McKibbin MA. Purtscher's and Purtscher-like retinopathies: a review. Surv Ophthalmol. 2006 Mar-Apr. 51(2):129-36.

2. Bhan K, Ashiq A, Aralikatti A, Menon KV, McKibbin M. The incidence of Purtscher retinopathy in acute pancreatitis. Br J Ophthalmol. 2008 Jan. 92(1):151-3. 

3. Sauer A, Nasica X, Zorn F, Petitjean P, Bader P, Speeg-Schatz C, et al. Cryoglobulinemia revealed by a Purtscher-like retinopathy. Clin Ophthalmol. 2007 Dec. 1 (4):555-7. 

4. Okwuosa TM, Lee EW, Starosta M, Chohan S, Volkov S, Flicker M, et al. Purtscher-like retinopathy in a patient with adult-onset Still's disease and concurrent thrombotic thrombocytopenic purpura. Arthritis Rheum. 2007 Feb 15. 57 (1):182-5

5. Dyrda A, Matheu Fabra A, Aronés Santivañez JR, Blanch Rubio J, Alarcón Valero I. Purtscher-like retinopathy as an initial presentation of iron-deficiency anaemia. Can J Ophthalmol. 2015 Feb. 50 (1):e1-2.

6. Landes A, Jay WM. Purtscher-like retinopathy in a patient with preeclampsia. Seminars in Ophthalmology. 2009. 24:217-220. 

7. Blodi BA, Johnson MW, Gass JD, Fine SL, Joffe LM. Purtscher's-like retinopathy after childbirth. Ophthalmology. 1990 Dec. 97(12):1654-9. 

8. Stewart MW, Brazis PW, Guier CP, Thota SH, Wilson SD. Purtscher-like retinopathy in a patient with HELLP syndrome. Am J Ophthalmol. 2007 May. 143(5):886-7. 

9. Chandra P, Azad R, Pal N, Sharma Y, Chhabra MS. Valsalva and Purtscher's retinopathy with optic neuropathy in compressive thoracic injury. Eye. 2005 Aug. 19(8):914-5. 

10. Chang M, Herbert WN. Retinal arteriolar occlusions following amniotic fluid embolism. Ophthalmology. 1984 Dec. 91(12):1634-7. 

11. Cooper BA, Shah GK, Grand MG. Purtscher's-like retinopathy in a patient with systemic lupus erythematosus. Ophthalmic Surg Lasers Imaging. 2004 Sep-Oct. 35(5):438-9.

12. Shah GK, Penne R, Grand MG. Purtscher's retinopathy secondary to airbag injury. Retina. 2001. 21(1):68-9.