Diagnostic Considerations

In addition to its known and reported association with pancreatitis, pregnancy and trauma, Purtscher-like retinopathy has now been reported to be associated with many systemic conditions including hemolytic uremic syndrome,^[16]myocardial infarction,^[17]viral infections,^{[18, 19]}and stem cell transplantation.^[20]Other recently reported causes include gemcitabine therapy,^[23]synthetic cannabinoids,^[22]and injection of drugs and other compounds.^{[23, 24]}

Differential Diagnoses

Central Retinal Artery Occlusion (CRAO)
Drug Reaction
Giant Cell Arteritis (Temporal Arteritis)
Hypertension
Iatrogenic
Interstitial Keratitis
Ocular Manifestations of HIV Infection
Sjogren Syndrome
Terson Syndrome

Workup

Agrawal A, McKibbin MA. Purtscher's and Purtscher-like retinopathies: a review. Surv Ophthalmol. 2006 Mar-Apr. 51(2):129-36. [QxMD MEDLINE Link].
Purtscher O. Noch unbekannte Befunde nach Schadeltrauma. Berl Dtsch Ophthal Ges. 1910. 36:294-301.
Agrawal A, McKibbin M. Purtscher's retinopathy: epidemiology, clinical features and outcome. Br J Ophthalmol. 2007 Nov. 91(11):1456-9. [QxMD MEDLINE Link].
Lai WW, Chen AC, Sharma MC, Lam DS, Pulido JS. Purtscher-like retinopathy associated with acute renal allograft rejection. Retina. 2005 Jan. 25(1):85-7. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Parc C. Purtscher-like retinopathy as an initial presentation of a thrombotic microangiopathy associated with antineoplastic therapy. Am J Hematol. 2007 Jun. 82(6):486-8. [QxMD MEDLINE Link].
Coban-Karatas M, Turunc T, Altan-Yaycioglu R. Purtscher-like retinopathy related to drug-induced hypersensitivity syndrome. Ocul Immunol Inflamm. 2012 Dec. 20 (6):475-7. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Harrison TJ, Abbasi CO, Khraishi TA. Purtscher retinopathy: an alternative etiology supported by computer fluid dynamic simulations. Invest Ophthalmol Vis Sci. 2011. 52(11):8102-7.
Landes A, Jay WM. Purtscher-like retinopathy in a patient with preeclampsia. Seminars in Ophthalmology. 2009. 24:217-220.
Holak HM, Holak S. Prognostic factors for visual outcome in purtscher retinopathy. Surv Ophthalmol. 2007 Jan-Feb. 52(1):117-8; author reply 118-9. [QxMD MEDLINE Link].
Blodi BA, Johnson MW, Gass JD, Fine SL, Joffe LM. Purtscher's-like retinopathy after childbirth. Ophthalmology. 1990 Dec. 97(12):1654-9. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Stroh I, Nguyen A, Channa R. Purtscher-Like Retinopathy in Hemolytic Uremic Syndrome. JAMA Ophthalmol. 2019 Jan 1. 137 (1):e183911. [QxMD MEDLINE Link].
Ang LJPS, Chang BCM. Purtscher-like retinopathy - A rare complication of acute myocardial infarction and a review of the literature. Saudi J Ophthalmol. 2017 Oct-Dec. 31 (4):250-256. [QxMD MEDLINE Link].
Lima LH, Vianello S, Pimentel S, Costa de Andrade G, Zett C, Muller L, et al. Dengue Fever Presenting as Purtscher-like Retinopathy. Ocul Immunol Inflamm. 2018. 26 (5):660-665. [QxMD MEDLINE Link].
Durrani AK, Mehta VJ, Kim SJ. Postinfluenza Purtscher-like Retinopathy with Acute Macular Neuroretinopathy. Ophthalmol Retina. 2018 Feb. 2 (2):95. [QxMD MEDLINE Link].
Castillo P, Voigt K, Crockett C, Stout JT, Krance R, Naik S. Purtscher-like retinopathy: A rare presentation of hematopoietic stem cell transplant-associated thrombotic microangiopathy. Pediatr Transplant. 2019 Mar. 23 (2):e13344. [QxMD MEDLINE Link].
Kovach JL. GEMCITABINE-INDUCED RETINOPATHY. Retin Cases Brief Rep. 2018 Summer. 12 (3):240-241. [QxMD MEDLINE Link].
Onaran Z, Akbulut Y, Tursun S, Oğurel T, Gökçınar N, Alpcan A. Purtscher-Like Retinopathy Associated with Synthetic Cannabinoid (Bonzai) Use. Turk J Ophthalmol. 2019 Apr 30. 49 (2):114-116. [QxMD MEDLINE Link].
Narendran S, Saravanan VR, Pereira M. Purtscher-like retinopathy: A rare complication of peribulbar anesthesia. Indian J Ophthalmol. 2016 Jun. 64 (6):464-6. [QxMD MEDLINE Link].
Khatibi A. BRAZILIAN BOOTY RETINOPATHY: PURTSCHER-LIKE RETINOPATHY WITH PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH PMMA INJECTION INTO BUTTOCKS. Retin Cases Brief Rep. 2018 Winter. 12 (1):17-20. [QxMD MEDLINE Link].
Ayaki M, Yokoyama N, Furukawa Y. Postpartum central retinal artery occlusion simulating Purtscher's retinopathy. Ophthalmologica. 1995. 209(1):37-9. [QxMD MEDLINE Link].
Campo SM, Gasparri V, Catarinelli G, Sepe M. Acute pancreatitis with Purtscher's retinopathy: case report and review of the literature. Dig Liver Dis. 2000 Nov. 32(8):729-32. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Chang M, Herbert WN. Retinal arteriolar occlusions following amniotic fluid embolism. Ophthalmology. 1984 Dec. 91(12):1634-7. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Fischbein F, Safir A. Monocular Purtscher's retinopathy. A fluorescein angiographic study. Arch Ophthalmol. 1971 Apr. 85(4):480-4. [QxMD MEDLINE Link].
Gass JD. Purtscher's-like retinopathy. Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment. Mo: Mosby: St. Louis; 1997. 452-454.
Jacob HS, Goldstein IM, Shapiro I, Craddock PR, Hammerschmidt DE, Weissmann G, et al. Sudden blindness in acute pancreatitis. Possible role of complement-induced retinal leukoembolization. Arch Intern Med. 1981 Jan. 141(1):134-6. [QxMD MEDLINE Link].
Kelley JS. Purtscher's retinopathy related to chest compression by safety belts. Fluorescein angiographic findings. Am J Ophthalmol. 1972 Aug. 74(2):278-83. [QxMD MEDLINE Link].
Marr WG, Marr EG. Some observations on Purtscher's disease: traumatic retinal angiopathy. Am J Ophthalmol. 1962. 54:693-705.
Pratt MV, De Venecia G. Purtscher's retinopathy: a clinicohistopathological correlation. Surv Ophthalmol. 1970 Mar. 14(5):417-23. [QxMD MEDLINE Link].
Shah GK, Penne R, Grand MG. Purtscher's retinopathy secondary to airbag injury. Retina. 2001. 21(1):68-9. [QxMD MEDLINE Link].
Shaikh S, Ruby AJ, Piotrowski M. Preeclampsia-related chorioretinopathy with Purtscher's-like findings and macular ischemia. Retina. 2003 Apr. 23(2):247-50. [QxMD MEDLINE Link].
Umlas JW, Hedges TR 3rd, Zbyszewski K. Purtscher's retinopathy in a patient with acute pancreatitis. Ophthalmic Surg Lasers. 2001 May-Jun. 32(3):263-4. [QxMD MEDLINE Link].
Miguel AI, Henriques F, Azevedo LF, Loureiro AJ, Maberley DA. Systematic review of Purtscher's and Purtscher-like retinopathies. Eye (Lond). 2013 Jan. 27 (1):1-13. [QxMD MEDLINE Link].

Media Gallery

Characteristic fundus findings of Purtscher retinopathy. Multiple cotton-wool spots surround the optic nerve after blunt thoracic trauma.
Mild Purtscher retinopathy in a patient after blunt chest compression as an unrestrained driver in a motor vehicle accident. This patient presented with visual loss in the left eye and had unilateral disease. The fundus photograph shows a large cotton-wool spot along the inferotemporal arcade and more subtle microvascular injury between the disc and fovea in the central macula. Whitening of the central fovea is present. Visual acuity was 20/200 but returned to 20/30 after 6 weeks.
Fluorescein angiogram of a patient who sustained blunt chest compression as an unrestrained driver in a motor vehicle accident shows focal microvascular occlusion in the area of the cotton-wool spot. Mild venous leakage and staining is seen in the perifoveal capillary bed just beneath the central fovea. A small amount of fluorescein leakage is also seen beneath the fovea.
Purtscher-like retinopathy in a patient with systemic lupus erythematosus with microvascular encephalopathy and retinopathy. Multiple cotton-wool spots of varying sizes and ages surround the optic nerve. A branch arterial occlusion is present along the supertemporal arcade with retinal whitening between the major artery and vein. Multiple occlusions are seen in arterial and venous trees with disruption of the blood columns.
Patient perception of visual deficits in an eye with Purtscher retinopathy

of 5

Author

Edward Chaum, MD, PhD Margy Ann and J Donald M Gass Professor of Ophthalmology, Vanderbilt Eye Institute; Professor of Pathology, Microbiology, and Immunology and Biomedical Engineering, Vanderbilt University Medical Center

Edward Chaum, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Telemedicine Association, Association for Research in Vision and Ophthalmology, Macula Society, Retina Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Andrew G Lee, MD Chair, Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital; Clinical Professor, Associate Program Director, Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch School of Medicine; Clinical Professor, Department of Surgery, Division of Head and Neck Surgery, University of Texas MD Anderson Cancer Center; Professor of Ophthalmology, Neurology, and Neurological Surgery, Weill Medical College of Cornell University; Clinical Associate Professor, University of Buffalo, State University of New York School of Medicine

Andrew G Lee, MD is a member of the following medical societies: American Academy of Ophthalmology, American Geriatrics Society, Houston Neurological Society, Houston Ophthalmological Society, International Council of Ophthalmology, North American Neuro-Ophthalmology Society, Texas Ophthalmological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AstraZeneca; Bristol Myers Squibb; Horizon<br/>Serve(d) as a speaker or a member of a speakers bureau for: Horizon<br/>Received ownership interest from Credential Protection for other.

Additional Contributors

Russell P Jayne, MD Vitreoretinal Surgeon, The Retina Center at Las Vegas

Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Retina Specialists

Disclosure: Nothing to disclose.

Sections Purtscher Retinopathy and Purtscher-like Retinopathy
Overview
Presentation
DDx
Workup
Treatment
Medication
Media Gallery
References

Purtscher Retinopathy and Purtscher-like Retinopathy Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

Contributor Information and Disclosures

What would you like to print?