Purtscher-like retinopathy following valsalva maneuver effect: case report

Abstract

Introduction: Purtscher's retinopathy is a rare condition that is noted in cases related to various types of trauma. The characteristic finding in the fundus is the presence of multiple Purtscher flecken. Purtscher-like retinopathy has a similar presentation in the fundus, but without an association with trauma.

Case presentation: A 43-year old Malay man presented with a sudden onset of central foggy vision in the left eye after holding his breath for two minutes while catching a falling object. It was not associated with floaters, flashes of light, or head trauma. His vision in the right eye was 6/6, and in his left eye it was finger counting. He had bilateral temporal sub-conjunctival hemorrhages. An examination of his left fundus revealed multiple white cotton wool spots and dot-blot retinal hemorrhages with diffuse retinal edema at the posterior pole. His right fundus was noted to have only mild temporal peri-papillary edema associated with a few dot-blot hemorrhages. Fundus fluorescein angiography showed good arterial perfusion and no evidence of leaking or neo-vascularization. A diagnosis of Purtscher-like retinopathy was made, and the patient was treated with indomethacin tablets for six weeks. At his six-week follow-up examination, his left eye visual acuity had improved to 6/12. His bilateral sub-conjunctival hemorrhage had resolved. His left fundus showed residual multiple cotton wool spots and reduced retinal edema.

Conclusions: Treatment with non-steroidal anti-inflammatory drugs seems to be effective in reducing edema in patients with Purtscher-like retinopathy.

Figure 1

Photograph showing sub-conjunctival hemorrhage in both eyes at presentation.

Figure 2

At the time of presentation, the patient's left fundus (right photograph) had multiple cotton wool spots of various sizes at the posterior pole, and his right fundus (left photograph) had mild temporal peri-papillary edema.

Figure 3

The patient's left fundus (right photo) showed resolving cotton wool spots, and his right fundus showed resolved temporal peri-papillary edema at the six-week follow-up examination.