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Retina

Case 75

Patient Presentation: A 52-year-old man was urgently consulted to the in-patient ophthalmology service for painless vision loss in both eyes upon regaining consciousness in the ICU. He was involved in a motor vehicle collision where he sustained significant traumatic head and chest injuries. He denied eye pain, flashes, floaters, or a visual field deficit. He had no past medical or ocular history. MRI brain revealed a small subarachnoid hemorrhage with no hydrocephalus or mass effect, that was being managed expectantly.

On examination, his visual acuity was 20/100 OD and CF OS. IOP was 13 OD and 15 OS. There was no RAPD. Slit lamp examination revealed bilateral focal subconjunctival hemorrhages, but an otherwise normal anterior segment. Dilated fundus examination revealed the following:

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Question 1: Describe the findings in these fundus photographs.

OCT macula images were taken and are shown below:

Question 2: Describe the main findings in the OCT images above.

Question 3: What is the most likely diagnosis?

Question 4: What is the pathogenesis and management of this disease?

References:

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Agrawal A, McKibbin MA. Purtscher's and Purtscher-like retinopathies: a review. Surv Ophthalmol. 2006 Mar-Apr;51(2):129-36. doi: 10.1016/j.survophthal.2005.12.003.

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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. doi: 10.1038/eye.2012.222.

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Gil P, Pires J, Costa E, Matos R, Cardoso MS, Mariano M. Purtscher retinopathy: to treat or not to treat? Eur J Ophthalmol. 2015 Oct 21;25(6):e112-5. doi: 10.5301/ejo.5000623.

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Learning Objectives:

  1. Recognize the clinical and OCT features of Purtscher’s retinopathy.

  2. Understand the pathogenesis and management of Purtscher’s retinopathy.

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