Purtscher's retinopathy

Purtscher's retinopathy
Classification and external resources
DiseasesDB	33929
eMedicine	article/1225431

Purtscher's retinopathy is a disease where part of the eye (retina) is damaged. Usually associated with severe head injuries, it may also occur with other types of trauma, such as long bone fractures, or with several non-traumatic systemic diseases. However, the exact cause of the disease is not well understood. There are no treatments specific for Purtscher's retinopathy, and the prognosis varies. The disease can threaten vision, sometimes causing temporary or permanent blindness.

It is named for the Austrian ophthalmologist, Othmar Purtscher (1852–1927), who detected it in 1910 and described it fully in 1912.

History of the disease

Purtscher's retinopathy was first characterized in 1910 and 1912 as a syndrome of sudden blindness after head trauma,^[1] with patches of hemorrhage and whitening of the retina in both eyes.^[2] Later, it was discovered to occur after other types of trauma, such as chest trauma, and is associated with several non-traumatic systemic diseases.^[2] Purtscher's retinopathy may also be associated with acute pancreatitis, vasculitis, embolization of such materials as fat and amniotic fluid,^[3] systemic lupus erythematosus, thrombotic thrombocytopenic purpura, and chronic renal failure.^[2] Purtscher's retinopathy may be caused by extensive fractures of the long bones.^[4]

Diagnosis

Where trauma is involved, only a funduscopic examination of the back of the eye (retina) is necessary to make the diagnosis.^[2] Fluoroscein angiography may show a decrease in blood flow to the areas of whiteness in the retina.

Pathophysiology

Purtscher's retinopathy likely involves complex pathophysiology, with several contributing factors, including complement-mediated aggregates, fat, air, fibrin clots and platelet clumps.^[5] The diseases leads to the formation of cotton wool spots in the retina, a finding observed in several other diseases, and atrophy of the optic nerve.^[2]

Associated diseases

• Severe head, chest, or long bone trauma
• Acute pancreatitis
• Amniotic fluid embolism
• Chronic renal failure
• Dermatomyositis
• Fat embolism syndrome
• Scleroderma
• Systemic lupus erythematosus (SLE)
• Thrombotic thrombocytopenic purpura (TTP)

Treatment

It may be treated with triamcinolone in some cases.^[6] However, in general, there are no treatments for Purtscher's retinopathy. If it is caused by a systemic disease or emboli, then those conditions should be treated.

Prognosis

Purtscher's retinopathy can lead to loss of vision,^[7] and recovery of vision may occur very little.^[2] However, vision recovery does occur in some cases, and reports have varied on the long-term prognosis.^[8]

References

1. Purtscher O (1912). "Angiopathia retinae traumatica. Lymphorrhagien des Augengrundes". Archives of Ophthalmology 82: 347–71. doi:10.1007/bf01929449.
2. Yanoff, Myron; Duker, Jay S. (2008). Ophthalmology (3rd ed.). Edinburgh: Mosby. pp. 750–754. ISBN 978-0323057516.
3. Retinopathy, Purtscher's at eMedicine
4. Chuang, EL; Miller FS, 3rd; Kalina, RE (March 1985). "Retinal lesions following long bone fractures.". Ophthalmology 92 (3): 370–4. doi:10.1016/s0161-6420(85)34023-x. PMID 3991127. Cite uses deprecated parameter |coauthors= (help);
5. Buckley, Sally A.; James, B (July 1996). "Purtscher's retinopathy.". Postgraduate Medical Journal 72 (849): 409–12. doi:10.1136/pgmj.72.849.409. PMC 2398519. PMID 8935600. Retrieved 2 December 2012.
6. Olson J, Rouhani B, Mandava N (March 2008). "Sub-Tenon's triamcinolone for post-partum Purtscher's-like retinopathy". Clinical Ophthalmology 2 (1): 195–8. doi:10.2147/opth.s2080. PMC 2698687. PMID 19668404.
7. Agrawal A, McKibbin M (Nov 2007). "Purtscher's retinopathy: epidemiology, clinical features, and outcome". British Journal of Ophthalmology 91 (11): 1456–9. doi:10.1136/bjo.2007.117408. PMC 2095457. PMID 17556428.
8. Schmidt, D; Otto, T (June 2004). "Prognosis and differential diagnosis of Purtscher's retinopathy". Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 101 (6): 576–83. doi:10.1007/s00347-003-0952-6. PMID 15197574.