What Is Purtscher Retinopathy?

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Purtscher retinopathy is an uncommon type of retinopathy, which are diseases of the retina, the light-sensing layer at the back of the eye. With this condition, central vision can be suddenly decreased or blurred.

There usually is a precipitating factor that sets off the condition. Typically, Purtscher usually is preceded by trauma, such as long-bone fractures of the leg, a crushing injury, or even a blow to the head, which can then lead to unexplained vision loss.

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Diseases such as acute pancreatitis (inflammation of the pancreas, an organ that aids in digestion and helps regulate blood sugar) and even pregnancy and childbirth also can lead to this eye condition.

Cases in which retinopathy symptoms are similar to those in Purtscher retinopathy but do not follow trauma are considered Purtscher-like retinopathy.

Purtscher Retinopathy Symptoms

With Purtscher retinopathy, people usually experience a painless decrease in vision that tends to occur within 24–48 hours of a traumatic event. In around 60% of cases, this occurs in both eyes. However, if someone has pancreatitis, then both eyes are nearly always affected.

Visual loss in the retina usually accompanies this condition. This is often in the form of a round or arc-shaped blind spot in the center or near the center of the visual field. Side vision, however, usually remains intact.

Causes

Trauma or disease can lead to Purtscher retinopathy.

Types of physical trauma leading to Purtscher retinopathy include:

  • A blow to the head
  • Repeated injuries or beatings to a child
  • Having undergone chest compressions
  • Breaking the long bone in your leg or having a crush injury
  • Having undergone orthopedic surgery
  • Lifting something heavy while breathing against a closed windpipe (Valsalva maneuver)

Some disease-related conditions that can lead to this condition involve the following:

  • Pancreas-related conditions such as acute pancreatitis (inflammation of the pancreas) or pancreatic adenoma (a benign tumor in the pancreas)
  • Pregnancy complications such as preeclampsia (a condition with high blood pressure and other system damage) or HELLP syndrome (stands for hemolysiselevated liver enzymes, and low platelet count)
  • Issues with connective tissues such as with lupus (an autoimmune disease causing inflammation and organ damage) or scleroderma (an autoimmune disease that causes excess collagen production and skin hardening and tightness)
  • Embolism-related problems (clots or other masses in the bloodstream)
  • Renal failure that's chronic

Diagnosis

Your healthcare professional will use your symptoms, medical history, and physical examination to determine whether Purtscher retinopathy is the cause of your sudden loss of vision,

In cases of Purtscher retinopathy, there must be a contributing event or illness, as well as what's known as cotton wool spots (fluffy white patches on the retina), or what's called Purtscher flecken (whitening of polygon-shaped areas of the inner retina in one or both eyes).

In Purtscher retinopathy, these patches would be on the back of the retina with little if any retinal hemorrhage (internal bleeding) found and not be associated with any kind of blow to the eye.

To make a diagnosis, healthcare providers will likely perform the following tests:

  • Optical coherence tomography (OCT) of the retina: This test uses light reflection to produce a detailed image. It may show high reflection in areas of fluffy, white cotton wool spots, some macular swelling (an area in the middle of the retina), and some damage to the retina, as well as photoreceptor (light-sensing cell) loss.
  • Fluorescein angiography: A glowing dye is injected into an arm vein and travels to the eye to bring blood vessels in the back of the eye into view so that images can be taken. This may show different kinds of blockages or leakage.

Your healthcare provider will consider other conditions that may possibly be the cause of vision loss instead of Purtscher retinopathy. There are many such conditions.

Treatment

The most important remedy for Purtscher retinopathy is to treat the underlying condition. Because Purtscher retinopathy is a rare condition, there are no set guidelines in treating it. Still, several treatment approaches have been successfully used.

One treatment that has been commonly tried is the use of high-dose intravenous corticosteroids. Although the use of steroids has not been studied in rigorous trials and remains controversial, this treatment has been successful in partially restoring nerve fibers that had not been irreversibly damaged.

Another common strategy is to take a wait-and-see approach and observe what happens while treating underlying conditions that may have caused Purtscher retinopathy (like pancreatitis). There is some evidence that this is as successful in recovering vision as using steroids, with the benefit of avoiding the side effects.

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as Indocin (indomethacin) has also been tried in some cases. These help to suppress the formation of prostaglandins in the system, which are hormones that collect when there is an injury. In some case reports, NSAID use has led to visual improvements.

Other treatments such as the use of hyperbaric oxygen (a chamber that provides increased oxygen) or of a muscle relaxant such as Pavabid (papaverine hydrochloride) have been suggested but studies have been too preliminary to recommend them as accepted treatment.

Prognosis

How much vision you are likely to recover with this condition depends on your case. In general, most people initially can only make out the big "E" on the Snellen eye chart (the eye chart often used in eye exams which has rows of letters of decreasing size). However, in about half of the cases, there's at least a two-line improvement in the ability to read the Snellen chart over time.

Summary

With Purtscher retinopathy, a traumatic event like a blow to the head often comes before retinal changes. In Purtscher-like retinopathy, instead of trauma, a condition such as preeclampsia or pancreatitis can first occur. Central vision is typically affected by either form of the condition.

Treatment usually involves high-dose steroid use or simple observation. Patients, in general, can expect to have their vision improve somewhat with time, although this varies from case to case.

A Word From Verywell

Purtscher retinopathy is a rare condition in which you may find yourself dealing with seemingly unexplained vision loss. But this is a condition that ophthalmologists are familiar with and will take steps to address. If you notice any unexplained vision loss, be sure to immediately reach out to your practitioner for help.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Massa R, Vale C, Macedo M, et al. Purtscher-like retinopathy. Case Reports in Ophthalmological Medicine. 2015;2015:1-5. doi:10.1155/2015/421329

  2. American Academy of Ophthalmology. Purtscher retinopathy and Purtscher-like retinopathy.

  3. Nor-Masniwati S, Azhany Y, Zunaina E. Purtscher-like retinopathy following valsalva maneuver effect: Case report. J Med Case Reports. 2011;5(1):338. doi:10.1186/1752-1947-5-338

By Maxine Lipner
Maxine Lipner is a long-time health and medical writer with over 30 years of experience covering ophthalmology, oncology, and general health and wellness.