Illustration of an eye showing neovascularization in Purtscher's retinopathy.

Purtscher's Retinopathy: When Trauma Affects Your Vision

Mira Elwood in Health & Wellness July 2025 • 4 min read.

"Discover how a rare eye condition linked to trauma can lead to vision loss and what treatments are available."

Purtscher's retinopathy, first identified in 1910 by Otmar Purtscher, is a rare visual impairment that develops following significant trauma. Initially observed in patients who experienced sudden blindness after severe injuries, the condition is characterized by distinct changes in the retina.

The hallmark of Purtscher's retinopathy is the appearance of cotton wool spots in the posterior pole of the eye. These spots are accompanied by other symptoms such as papillitis, intraretinal hemorrhages, and preretinal hemorrhages. The severity of vision loss can vary significantly, often affecting both eyes.

Visual symptoms may appear immediately or within 48 hours after the traumatic event. In many cases, vision improves spontaneously within one to three months without intervention. However, the fundus examination may reveal lasting effects, including mottling of the retinal pigment epithelium, temporal disk pallor, and vessel abnormalities. In rare instances, neovascularization, or the formation of new blood vessels, can occur, further complicating the condition.

Understanding the Case: A Teen's Battle with Purtscher's Retinopathy

Illustration of an eye showing neovascularization in Purtscher's retinopathy.

A 14-year-old boy was admitted to an ophthalmology service with complaints of new-onset blurred vision and floaters in both eyes. This followed a traumatic incident a few days prior, where he sustained multiple facial and skull fractures after being struck by a truck while riding his bike. Additional injuries included a lacerated liver and pancreas, a minor pneumothorax, and a pelvic hematoma, none of which required surgery.

His medical history was notable for cerebellar medulloblastoma, treated six years earlier with surgery, radiation, and chemotherapy. Upon initial examination, his visual acuity was 20/400 in the right eye and he could only count fingers at five feet in the left eye. He had no afferent pupillary defect. Intraocular pressure was 21 mmHg in the right eye and 19 mmHg in the left eye. A slit-lamp examination revealed some cell presence in the anterior vitreous of the right eye.

Fundus Examination: Showed disk edema, retinal whitening, and retinal hemorrhages in both eyes.
Optical Coherence Tomography (OCT): Revealed atrophy of the temporal retina and disruption of the inner segment-outer segment junction of the photoreceptor layer in the right eye, as well as thickening and edema of the nasal macula and central foveal hyper-reflectivity consistent with a scar in the left eye.

One month later, the right eye showed no neovascularization, but the left eye developed neovascularization of the disk and ischemia in the mid-periphery. The patient underwent pan-retinal photocoagulation. Five months post-presentation, his visual acuity slightly improved to 20/200 in the right eye and 20/300 in the left eye, with regression of neovascularization. He was then referred to low vision services.

Navigating the Challenges of Purtscher's Retinopathy

Purtscher's retinopathy following trauma can, in rare cases, lead to neovascularization and ischemia. Despite treatment, the visual prognosis should be approached with caution. Further research is needed to fully understand this rare condition and improve outcomes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2147/opth.s26076, Alternate LINK

Title: Neovascularization In Purtscher'S Retinopathy

Subject: Ophthalmology

Journal: Clinical Ophthalmology

Publisher: Informa UK Limited

Authors: Theodore Leng, Chan, Douglas Fredrick

Published: 2011-11-01

Everything You Need To Know

What is Purtscher's retinopathy, and what are its primary characteristics?

Purtscher's retinopathy is a rare eye condition that typically arises after significant traumatic injuries. The most prominent sign of this condition is the appearance of cotton wool spots in the posterior pole of the eye. Other characteristics include papillitis, intraretinal hemorrhages, and preretinal hemorrhages. The severity of vision loss can vary widely and frequently affects both eyes. These features are key indicators that help doctors diagnose and differentiate Purtscher's retinopathy from other eye conditions.

How quickly do symptoms of Purtscher's retinopathy appear after a traumatic event, and how does vision typically change over time?

Visual symptoms of Purtscher's retinopathy can manifest immediately or within 48 hours following a traumatic incident. In many cases, vision spontaneously improves within one to three months without specific interventions. However, even if vision improves, fundus examinations may reveal lasting effects, such as mottling of the retinal pigment epithelium, temporal disk pallor, and vessel abnormalities. In rare situations, neovascularization can occur, complicating the prognosis.

What kind of eye examination methods are used to diagnose Purtscher's retinopathy?

Diagnosing Purtscher's retinopathy involves several examination methods. A fundus examination is crucial, as it allows doctors to observe the hallmark signs like cotton wool spots and hemorrhages within the retina. Optical Coherence Tomography (OCT) is also used to provide detailed images of the retinal layers, identifying any structural damage, such as atrophy or disruption in the photoreceptor layer. The slit-lamp examination might reveal the presence of cells in the anterior vitreous. These combined assessments help confirm the diagnosis.

Can you describe a specific case of Purtscher's retinopathy and the course of treatment?

A 14-year-old boy presented with blurred vision and floaters in both eyes after sustaining multiple facial and skull fractures from a bike accident. Initial examination revealed disk edema, retinal whitening, and retinal hemorrhages. Optical Coherence Tomography (OCT) showed retinal damage. One month later, the left eye developed neovascularization, leading to pan-retinal photocoagulation treatment. Five months post-presentation, his vision slightly improved, but he was referred to low vision services, illustrating the complex nature of the condition and the need for ongoing care.

What are the long-term implications and prognosis for individuals with Purtscher's retinopathy?

The visual prognosis for Purtscher's retinopathy should be approached with caution. While vision often improves spontaneously, the condition can lead to lasting effects like retinal pigment mottling and vessel abnormalities. In rare cases, neovascularization and ischemia can develop, requiring treatment. The long-term implications vary, and although some individuals may experience significant vision recovery, others may face persistent visual impairment. Further research is necessary to fully understand the condition and to improve outcomes.