Purtscher Retinopathy: An Eye On Acute Pancreatitis
Tin Nguyen
Family
1
MD ;
1
Medicine
Eleanor Loomis MD,
and Internal
Raja Jagadeesan MD, MS,
Residency Programs, UC Davis School of Medicine
3
Sacramento VA Hospital
Images
Discussion
Purtscher Retinopathy: Uncommonly Recognized
Complication of Acute Pancreatitis
Case Description
•  ID
•  25 year old man with history of alcohol abuse
presented with acute necrotizing pancreatitis.
Figure 1
•  HPI
•  Acute onset of epigastric pain, nausea, vomiting
and elevated lipase.
•  Development of pseudocyst, paracolic fluid, pleural
effusion, mild pericardial effusion, acute tubular
necrosis requiring hemodialysis.
•  ROS
•  Blurry vision and decreased ability to see faces
with onset of abdominal pain.
•  PE
•  OD 20/160, OS 20/250
•  Dilated fundus exam: cotton wool spots,
peripapillary hemorrhages, and mild macular
edema
•  Hospital Course
•  Developed hemorrhagic phlegmon and PEA arrest
following blood transfusion.
•  Pancreatitis resolved and discharged after two
months hospital stay with continued outpatient
hemodialysis.
•  No further documentation regarding vision changes
or improvements noted prior to discharge.
2,3
MPH
2
Medicine
Learning Objectives
•  Recognize Purtscher Retinopathy as an uncommon
complication of acute pancreatitis.
•  Understand the epidemiology, pathogenesis, clinical
findings and management of Purtscher Retinopathy.
2
MPH ;
•
Epidemiology
•
0.24 persons per 1 million
•
Up to 10 percent of acute pancreatitis
•
Pathogenesis
•
Complement activation  embolic phenomena 
vascular occlusion of retinal arterioles
•
Clinical and Objective findings
•
Asymptomatic to significant visual loss
•
“Purtscher flecken”, cotton wool spots, retinal
hemorrhages or macular edema
•
Management
•
Supportive approach initially
•
Limited data support IV and then PO steroids
•
Lessons
•
Recognize and diagnose rare complication
associated with pancreatitis
•
Provide counseling for potentially distressing
symptom
•
Role for medical treatment if no spontaneous
resolution
Figure 2
Figure 1 and 2: Bilateral dilated fundoscopic exam
illustrating cotton wool spots, peripapillary
hemorrhages and mild macular edema consistent with
Purtscher Retinopathy.
Commonly Recognized Complications of Acute
Pancreatitis
References
Figure 3: Acute
Walled Off Necrotic
Fluid Collections
Figure 5: CT – Pleural Effusion
Figure 4: Hemorrhagic
Phlegmon
Figure 6: CXR -Pleural
Effusion
1) Mayer C, Khoramnia R. Purtscher‐like re;nopathy caused by acute pancrea;;s Lancet 2011; 378: 1653 2) Carrera CR, Pierre LM, Medina FM, Pierre‐Filho Pde T. Purtscher‐like re;nopathy associated with acute pancrea;;s. Sao Paulo Med J. 2005 Nov 3;123(6):289‐91. 3) Agrawal A, McKibbin M. Purtscher's re;nopathy: epidemiology, clinical features and outcome. Br J Ophthalmol. 2007 Nov;91(11):1456‐9. 4) Bhan K, Ashiq A, AralikaZ A, Menon KV, McKibbin M. The incidence of Purtscher re;nopathy in acute pancrea;;s. Br J Ophthalmol. 2008 Jan;92(1):151‐3 5) Agrawal A, McKibbin MA. Purtscher's and Purtscher‐like re;nopathies: a review. Surv Ophthalmol. 2006 Mar‐Apr;51(2):129‐36. 6) Shapiro I, Jacob HS. Leukoemboliza;on in ocular vascular occlusion. Ann Ophthalmol. 1982 Jan;14(1):
60‐2 7) Holak HM, Holak S. Prognos;c factors for visual outcome in purtscher re;nopathy.Surv Ophthalmo. 2007 Jan‐Feb;52(1):117‐8; author reply 118‐9.