Purtscher syndrome (fat embolism syndrome; traumatic retinal angiopathy; traumatic liporrhagia; valsalva retinopathy of duane; duane retinopathy)

General: Most frequently seen in accidents associated with sudden rise in blood pressure and congestion in the head and chest; presence of fat embolism may be the causative factor; neurovascular changes in retina referred to as traumatic retinal angiopathy; several mechanisms have been proposed, including compressive trauma and posttraumatic fat embolism; most likely mechanism appears to be leukocyte aggregation by activated complement factor 5 (C5A), which can occur in diverse conditions such as trauma, acute pancreatitis, and connective tissue disease.

Ocular: Retinal and preretinal hemorrhages over entire fundus; cotton-wool exudates, mainly posterior aspect; retinal edema; posterior and macular serous detachment; venous congestion and engorgement; papilledema; usually bilateral, although unilateral causes have been reported.

Clinical: Multiple fractures (mainly extensive crushing); lung congestion; dyspnea; lymphorrhagia; pancreatitis; scleroderma; dermatomyositis; lupus erythematosus; childbirth.

Burton TC. Unilateral Purtscher's retinopathy. Ophthalmology 1980; 87:1096-l105.

Hoare GW. Traumatic retinal angiopathy resulting from chest compression by safety belt. Br J Ophthalmol 1970; 54:667.

Inkeles DM, et al. Purtscher's retinopathy in acute pancreatitis. Am J Med Sci 1976; 2772:335-338.

Kelley JS, Dhaliwal RS. Traumatic chorioretinopathies. In: Ryan S, ed. Retina. vol. II, 2nd ed. St. Louis: Mosby, 1994.

Purtscher O. Angiopathia Retinae Traumatica. Lymphorrhagien des Augengrundes. Graefes Arch Clin Exp Ophthalmol 1912; 82:341.