Purtscher retinopathy, a rare form of retinal disease, is a disease of the retina, the light-sensitive layer at the back of the eye. In this condition, central vision may suddenly decrease or blur.
There is usually a predisposing factor that triggers this. Typically, Purtscher has been preceded by trauma, such as a broken long bone in the leg, crush injuries, or even a blow to the head, which can lead to unexplained vision loss.
Acute pancreatitis (inflammation of the pancreas, an organ that helps digest and regulate blood sugar) and even conditions such as pregnancy and childbirth can cause this eye disorder.
Cases of retinopathy with symptoms similar to Purtscher retinopathy without trauma are considered Purtscher-like retinopathy.
Purtscher retinopathy symptoms
With Purtscher retinopathy, people typically experience painless vision loss within 24-48 hours of the traumatic event. In about 60% of cases, this occurs in both eyes. However, if someone has pancreatitis, almost both eyes are affected.
Retinal vision loss often accompanies this condition. This is usually in the form of a circular or arcuate blind spot at or near the center of the field of view. However, the side view usually remains intact.
Trauma or disease can cause Purtscher’s retinopathy.
Types of physical trauma that lead to Purtscher retinopathy include:
- hit to the head
- Repeatedly hurting or hitting a child
- received chest compressions
- broken long bones in the leg or crush injuries
- orthopedic surgery
- Lift heavy objects while breathing into a closed windpipe (Valsalva maneuver)
Some disease-related conditions that can cause this include:
- Pancreatic-related disorders, such as acute pancreatitis (inflammation of the pancreas) or pancreatic adenoma (benign tumor of the pancreas)
- Pregnancy complications, such as preeclampsia (a condition of high blood pressure and other systemic damage) or HELLP syndrome (representing hemolysis, elevated liver enzymes, and low platelet counts)
- Connective tissue problems, such as lupus (an autoimmune disease that causes inflammation and organ damage) or scleroderma (an autoimmune disease that causes overproduction of collagen and hardened and tight skin)
- Embolism-related problems (clots or other lumps in the blood)
- chronic renal failure
Your healthcare professional will determine whether Purtscher retinopathy is the cause of your sudden blindness based on your symptoms, medical history, and physical examination,
In the case of Purtscher retinopathy, there must be a contributing event or disease, as well as so-called cotton wool spots (flaky white patches on the retina), or so-called Purtscher flecken (whitening of polygonal areas of the inner retina) in one or both eyes ).
In Purtscher retinopathy, these plaques are located on the back of the retina, hardly any retinal hemorrhages (internal hemorrhages) are found, and they are not associated with any form of eye blow.
To make a diagnosis, a healthcare provider may perform the following tests:
- Optical coherence tomography (OCT) of the retina: This test uses light reflections to produce detailed images. It may show hyperreflection in areas of fluffy white cotton wool spots, some macular swelling (the area in the middle of the retina), and some damage to the retina, and loss of photoreceptor cells (photoreceptors).
- Fluorescein angiography: A light-emitting dye is injected into a vein in the arm and into the eye, bringing the blood vessels at the back of the eye into the field of view so that images can be taken. This may indicate a different type of blockage or leak.
Instead of Purtscher’s retinopathy, your healthcare provider will consider other conditions that can cause vision loss. There are many such conditions.
The most important treatment for Purtscher retinopathy is to treat the underlying disease. Because Purtscher’s retinopathy is a rare disease, there are no fixed treatment guidelines. Nonetheless, several treatments have been used successfully.
A common treatment is the use of high-dose intravenous corticosteroids. Although steroid use has not been studied in rigorous trials and remains controversial, this treatment has been successful in partially restoring nerve fibers that have not been irreversibly damaged.
Another common strategy is to take a wait-and-see approach and see what happens when an underlying condition that can cause Purtscher’s retinopathy, such as pancreatitis, is treated. There is some evidence that this is as successful in restoring vision as using steroids and avoids side effects.
In some cases, nonsteroidal anti-inflammatory drugs (NSAIDs), such as Indocin (indomethacin), have also been tried. These help inhibit the formation of prostaglandins in the system, hormones that are collected during injury. In some case reports, the use of NSAIDs resulted in improved vision.
Other treatments have been proposed, such as the use of hyperbaric oxygen (a chamber that provides increased oxygen) or muscle relaxants such as Pavabid (papaverine hydrochloride), but research is too preliminary to recommend them as an accepted treatment.
How much vision you may regain in this situation depends on your condition. In general, most people initially only recognize the large “E” on the Snellen chart (a chart commonly used for eye exams, which has a row of letters of decreasing size). However, in about half of the cases, the ability to read Snellen’s chart improved by at least two lines over time.
With Purtscher retinopathy, traumatic events like a blow to the head often precede retinal changes. In Purtscher-like retinopathy, conditions such as preeclampsia or pancreatitis may first appear rather than trauma. Central vision is usually affected by any form of the condition.
Treatment usually involves the use of high-dose steroids or simple observation. In general, patients’ vision improves over time, although this varies from case to case.
Purtscher retinopathy is a rare condition where you may find yourself dealing with seemingly unexplained vision loss. But this is a situation that ophthalmologists are familiar with and will take steps to address. If you notice any unexplained vision loss, be sure to seek help from your doctor right away.