Three Cases of Missed Purtscher’s Retinopathy

Purpose : Visual loss associated with multiple traumas in the context of road traffic accident, especially when the maxillofacial and orbital areas are not directly injured, is an uncommon occurrence. The possibility of Purtscher’s retinopathy, i.e. retinal manifestation of mechanical trauma elsewhere in the body, as the cause of visual disturbance in these situations can often be overlooked.Patients Methods : We present three cases of Purtscher’s retinopathy where the diagnosis was initially missed. All three patients presented to Accident and Emergency department with visual loss in the left eyes, having sustained compressive chest and/or abdominal injuries in road traffic accidents. None had direct trauma to the orbital region. Serial color fundus photographs, fluorescein angiogram, Goldman visual fields, and electro diagnostic tests were performed on each patient, with a mean follow-up of 8.3 months (Range 6 to 10 months). The correct diagnosis of Purtscher’s retinopathy was made retrospectively in all three cases. Two patients had persistent central scotoma despite complete resolution of the retinal signs.Conclusion : Purtscher’s retinopathy should be considered as a differential diagnosis in all cases of unexplained visual loss associated with multiple traumas. The retinal manifestations of Purtscher’s retinopathy can disappear in a short time interval. A retrospective diagnosis may be difficult in the absence of any fundal abnormalities if the diagnosis is initially missed on presentation