Purtscher-Like Retinopathy in a Patient with COVID-19

Abstract

The emerging literature on the novel coronavirus pandemic has reported several cases of varied retinal findings in patients with COVID-19. We report the case of a 59-year-old male who presented with complaint of bilateral blurry vision following hospital discharge after prolonged hospitalization for severe COVID-19 illness. On ocular exam, the patient demonstrated bilateral cotton wool spots localized to the posterior pole of each eye. Multimodal imaging demonstrated findings consistent with retinal nerve fiber layer infarcts in the areas of the cotton wool spots. Exam and imaging of our patient were most consistent with a Purtscher-like retinopathy. We suggest that as ophthalmologists care for increasing numbers of patients recuperating from COVID-19, they monitor for microangiopathic changes similar to those in our patient.

Figure 1

Fundus photos demonstrating cotton wool spots in the posterior pole of each eye at presentation (a–d) and their interval reduction at two-month follow-up (e, f).

Figure 2

OCT demonstrated normal foveal contour in both eyes (a, b). OCT through an area of inner retinal opacification in the left eye (c, d) revealed thickening and hyperreflectivity of the nerve fiber layer. FA was largely unremarkable (e–h) aside from mild obscuration of the retinal vasculature in areas of inner retinal opacification. OCTA (i–l) sectioned at the superficial capillary plexus demonstrated flow voids corresponding to the cotton wool spots.