Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!

At a glance

Purtscher’s retinopathy is a rare retinal disorder characterized by acute visual loss and retinal findings (cotton-wool spots, intraretinal hemorrhages and retinal whitening) following head or chest trauma. Purtscher-like retinopathy is an acquired form of retinopathy due to hemorrhagic or vasoocclusive vasculopathy associated with acute pancreatitis, renal failure, autoimmune diseases, and thrombotic microangiopathies.

Synonyms

Purtscher Angiopathic Retinopathy; Purtscher-Like Retinopathy.

History

First described in 1912 by Austrian ophthalmologist, Othmar Purtscher, as a syndrome of sudden blindness associated with severe head trauma. These patients presented with multiple white retinal patches and retinal hemorrhages associated with severe vision loss.

Incidence

Very rare, estimated incidence of 0.24 per 1,000,000 patients per annum.

Genetic inheritance

Acquired disease. Associated underlying diseases may have genetic component.

Diagnosis

Purtscher retinopathy is diagnosed when at least three of the five following criteria are fulfilled: Purtscher flecken, 1 to 10 retinal hemorrhages, cotton-wool spots, probable or plausible explanatory etiology, and complementary investigation compatible with the diagnosis.

Clinical aspects

The clinical findings have traditionally been associated with severe crush injuries. However, Purtscher-like retinopathy has also been reported in association with pancreatitis, thrombocytopenic purpura, Hemolytic Uremic Syndrome, systemic lupus erythematosus, dermatomyositis, scleroderma, and amniotic fluid embolism. The ophthalmoscopic findings associated with this syndrome are peripapillary cotton-wool spots, intraretinal hemorrhages, asymmetrical venous engorgement, and retinal whitening. The circumstances in which Purtscher retinopathy develops determine the clinical picture.

Anesthetic considerations

The anesthetic management needs to take into consideration the different causes of the underlying pathology. To avoid sudden increases in intraocular pressure, medication susceptible to affect it such as succinylcholine and ketamine should be avoided if possible. Moderate hyperventilation can contribute to reduce intraocular pressure.

References

+
Power  MH, Regillo  CD, Custis  PH: Thrombocytopenic purpura associated with Purtscher’s retinopathy. Arch Ophthalmol[Archives of Ophthalmology Full Text] 115:128, 1997.  [PubMed: 9006443]
+
Ustaoğlu  M, Önder  F, Solmaz  N,  et al: Purtscher-like retinopathy associated with atypical hemolytic uremic syndrome. Turk J Ophthalmol 47:348, 2017.  [PubMed: 29326853]

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.