Purtscher’s Retinopathy: Overview and More
Purtscher’s retinopathy is a rare type of retinopathy, which are diseases of the retina, the light-sensitive layer at the back of the eye. With this condition, central vision may suddenly be diminished or blurred.
There is usually a triggering factor that triggers the condition. Typically, Purtscher is usually preceded by trauma, such as a fracture of the long bones of the leg, a crush injury, or even a blow to the head, which can then lead to unexplained loss of vision.
Diseases such as acute pancreatitis (inflammation of the pancreas, an organ that aids digestion and helps regulate blood sugar) and even pregnancy and childbirth can also lead to this eye condition.
Cases in which the symptoms of retinopathy are similar to those of Purtscher’s retinopathy but do not result from trauma are considered Purtscher-type retinopathy.
Symptoms of Purtscher’s Retinopathy
With Purtscher’s retinopathy, people typically experience a painless decrease in vision that tends to occur within 24 to 48 hours of a traumatic event. In about 60% of cases, this occurs in both eyes. However, if someone has pancreatitis, both eyes are almost always affected.
Visual loss in the retina usually accompanies this condition. This often presents as a round or arc-shaped blind spot at or near the center of the visual field. Lateral vision, however, usually remains intact.
Trauma or disease can lead to Purtscher’s retinopathy.
Types of physical trauma leading to Purtscher’s retinopathy include:
- A blow to the head
- Repeated injuries or blows to a child
- Have undergone chest compressions
- Break the long bone of the leg or have a crush injury
- Having undergone orthopedic surgery
- Lifting something heavy while breathing against a closed trachea (Valsalva maneuver)
Some disease-related conditions that can lead to this condition involve the following:
- Pancreatic-related conditions such as acute pancreatitis (inflammation of the pancreas) or pancreatic adenoma (a benign tumor of the pancreas)
- Pregnancy complications such as preeclampsia (a condition characterized by high blood pressure and other systemic damage) or HELLP syndrome (means hemolysis, elevated liver enzymes, and low platelet count)
- Problems with connective tissues such as lupus (an autoimmune disease causing inflammation and organ damage) or scleroderma (an autoimmune disease that causes excess collagen production and hardening and tightness of the skin)
- Embolism-related problems (clots or other masses in the blood)
- Chronic renal failure
Your healthcare professional will use your symptoms, medical history, and physical exam to determine if Purtscher’s retinopathy is the cause of your sudden vision loss.
In cases of Purtscher’s retinopathy, there must be a contributing event or disease, as well as so-called cotton wool spots (fluffy white spots on the retina), or so-called Purtscher flecken (whitening of the areas polygon-shaped inner retina in one or both eyes).
In Purtscher’s retinopathy, these patches would be on the back of the retina with little or no retinal hemorrhage (internal bleeding) and would not be associated with any type of eye poke.
To make a diagnosis, healthcare providers will likely do the following tests:
- Optical coherence tomography (OCT) of the retina: this test uses the reflection of light to produce a detailed image. It may show high reflectance in areas of fluffy white cotton spots, macular swelling (an area in the middle of the retina) and retinal damage, and photoreceptor (light sensitive cell) loss.
- Fluorescein angiography: A glowing dye is injected into a vein in the arm and travels to the eye to highlight blood vessels in the back of the eye so images can be taken. This can show different types of blockages or leaks.
Your health care provider will consider other conditions that may possibly be the cause of vision loss instead of Purtscher’s retinopathy. There are many such conditions.
The most important cure for Purtscher’s retinopathy is to treat the underlying condition. Because Purtscher’s retinopathy is a rare condition, there are no established guidelines for treating it. Yet, several treatment approaches have been used successfully.
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 succeeded 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 when treating underlying conditions that may have caused Purtscher’s retinopathy (such as pancreatitis). There is evidence that it is as successful in recovering vision as using steroids, with the added benefit of avoiding side effects.
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as Indocin (indomethacin) has also been tried in some cases. These help suppress the formation of prostaglandins in the system, which are hormones that build up when injured. In some case reports, the use of NSAIDs has resulted in visual improvements.
Other treatments such as the use of hyperbaric oxygen (a chamber that provides an increase in oxygen) or a muscle relaxant such as Pavabid (papaverine hydrochloride) have been suggested but the studies have been too preliminary for them. recommend as accepted treatment.
The degree of vision you are likely to recover with this condition depends on your case. Typically, most people can only make out the big “E” on the Snellen eye chart (the eye chart often used in eye exams that has rows of letters of decreasing size) at first. However, in about half of the cases, there is at least a two-line improvement in the ability to read the Snellen chart over time.
With Purtscher’s retinopathy, a traumatic event like a blow to the head often occurs before the retinal changes. In Purtscher-type retinopathy, instead of trauma, a condition such as preeclampsia or pancreatitis may first occur. Central vision is usually affected by one or another form of the condition.
Treatment usually involves the use of high dose steroids or simple observation. Patients, in general, can expect to see some improvement in their vision over time, although this varies from case to case.
A word from Verywell
Purtscher’s retinopathy is a rare condition in which you may find yourself experiencing seemingly unexplained vision loss. But it is a condition that ophthalmologists are aware of and will take steps to address. If you notice unexplained vision loss, be sure to contact your practitioner immediately for assistance.