This 24YO male had a history of acute alcohol-related pancreatitis one month earlier and presented with bilateral multifocal areas of superficial peripapillary retinal whitening.
OCT scanning showed small hyperreflective areas spanning the inner plexiform, inner nuclear, and outer plexiform layers.
Learning Points:
Purtscher’s retinopathy was first described by Otmar Purtscher in 1910. Although originally described in a man who fell from a tree with cranial trauma, these white patches of retinal ischemia and hemorrhages are found in numerous other etiologies, including pancreatitis, chest trauma, and collagen vascular diseases.
The findings are called Purtscher’s retinopathy when due to trauma, and Purtscher ‘s-like retinopathy when seen from other causes, as in this case.
The underlying cause of Purtscher’s is unknown, but it is thought to involve leukoembolization due to complement activation. The areas of ischemia include more superficial nerve fiber layer infarcts (cotton wool spots) and deeper ischemia involving the middle retinal layers (paracentral middle maculopathy).
