# Purtscher Retinopathy Resulting from a Car Crash Accident—Multimodal Imaging Value

## TL;DR

A 72-year-old woman developed Purtscher retinopathy after a car crash, showing how trauma can lead to sudden vision loss and the importance of multimodal imaging in diagnosis.

## Contribution

The case highlights the value of multimodal imaging in diagnosing Purtscher retinopathy following trauma in an older female patient.

## Key findings

- Purtscher retinopathy occurred in a 72-year-old woman after a car crash, showing typical bilateral symptoms.
- Multimodal imaging helped confirm the diagnosis despite the rarity of the condition in older females.
- The prognosis was influenced by age and delayed treatment, leading to a less favorable outcome.

## Abstract

Purtscher retinopathy is a rare but severe sight-threatening eye condition that mostly occurs in middle-aged men after chest compression or head injury. In cases such as acute pancreatitis, connective tissue disorders, kidney failure or COVID-19 infection with similar ocular findings but no history of trauma, a diagnosis of Purtscher-like retinopathy is made. We present a case of a 72-year-old female with typical symptoms of Purtscher retinopathy in both eyes after a car crash accident. Although the pathophysiology of the disease is not fully understood, the main cause of Purtscher retinopathy seems to be an embolic occlusion of the precapillary arterioles which supply the superficial peripapillary capillaries. Activation of the C5a component of the complement predisposes the leukocytes to aggregation, which obstructs blood flow. The main symptom of Purtscher retinopathy is sudden, painless deterioration of vision which occurs up to 48 h after the injury. In most patients, the changes observed in the fundus of the eye resolve within several months, and visual acuity slowly improves, sometimes even returning to the state from before the injury. However, risk factors such as older age, high hyperopia, and late treatment implementation can make the prognosis less favorable.