A 30-year-old man develops sudden blurred vision two days after sustaining severe blunt chest trauma in a road accident. Fundus shows numerous cotton wool spots and superficial hemorrhages clustered around both optic discs with sparing of the extreme periphery. The most likely diagnosis is:
- A Central retinal vein occlusion
- B Commotio retinae
- C Valsalva retinopathy
- D Purtscher retinopathy ✓
Explanation
Purtscher retinopathy follows major trauma such as chest compression or head injury, and also occurs in acute pancreatitis. It shows bilateral patches of retinal whitening (Purtscher flecken), cotton wool spots, and hemorrhages concentrated around the optic disc with a characteristic spared zone at the periphery, reflecting complement-mediated leukocyte embolization of precapillary arterioles. Valsalva retinopathy shows premacular hemorrhage without cotton wool spots, commotio retinae follows direct globe trauma with outer retinal whitening, and CRVO presents with diffuse quadrant-involving dot-blot hemorrhages and tortuous dilated veins.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.