Features
Purtscher and Purtscher-like retinopathies are a group of retinal vascular diseases secondary to trauma or other disease processes with characteristic retinal findings, including polygonal inner retinal whitening, cotton wool spots, and intraretinal hemorrhages. The most common cause is trauma; however, cases have been reported secondary to numerous other pathologies including acute pancreatitis, valsalva, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, cryoglobulinemia, pregnancy, and connective tissue disorders. Impact on vision may range from asymptomatic to hand-motions vision, and may be delayed 24 to 48 hours following the instigating event. Purtscher retinopathy is most commonly bilateral, but unilateral cases have been described.
82.1.1 Common Symptoms
Variable vision loss ranges from none to hand-motion level visual acuity. Vision loss may be delayed 24 to 48 hours following the instigating event. Central, paracentral, or arcuate scotomata may be present with preservation of peripheral visual field.
82.1.2 Exam Findings
Most common findings are cotton wool spots, retinal hemorrhages, and Purtscher Flecken (i.e., areas of polygonal, retinal whitening in the superficial, inner retina, with a clear demarcating line, with 50 µm between the affected retina and retinal vasculature, ▶ Fig. 82.1). These typically present in the posterior pole and area immediately nasal to the optic disc. Pseudo-cherry red spot with surrounding retinal whitening and optic disc edema may be present. Most cases are bilateral. Retinal vessels appear healthy.
Fig. 82.1 Fundus photograph of optic nerve and peripapillary retina demonstrating extensive cotton wool spots with associated retinal hemorrhage in a Purtscher-like presentation related to an exacerbation of pemphigus vulgaris.
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