Purtscher's retinopathy: epidemiology, clinical features and outcome

To study the incidence, systemic associations, presenting features and natural history of Purtscher's retinopathy in the UK and Ireland.

Cases were collected prospectively by active surveillance through the British Ophthalmological Surveillance Unit. Clinical details were obtained using an incident questionnaire, with follow-up at 1 and 6 months.

Clinical details were obtained for 15 cases over 12 months. These were associated with road traffic accidents in 6 cases, chest compression in 6 cases and acute pancreatitis in 3 cases. All cases were symptomatic and presented with loss of visual acuity, visual field or a combination. Bilateral involvement was noted in 9 cases. The acute retinal signs of cotton wool spots, retinal haemorrhage and Purtscher flecken cleared within 1 month in 26% of eyes and within 6 months in all eyes. The most common chronic signs were optic disc pallor and atrophy of the retinal pigment epithelium. Without treatment, 50% of eyes improved by at least 2 Snellen lines at final follow-up and 23% improved by at least 4 Snellen lines. Only 1 of the 24 eyes had a final acuity worse than that recorded at presentation.

Purtscher's retinopathy is a rare but sight-threatening eye condition, most commonly seen in young or middle-aged men and after trauma. Spontaneous visual recovery of at least 2 Snellen lines is seen in half of the cases.