Ocular manifestations of acute pancreatitis: Purtscher’s retinopathy

Purtscher’s retinopathy is a posterior segment condition which is most often a consequence of head, neck or thoracic injury. It is a rare disease that can also be seen in patients who suffer from systemic disorders such as acute pancreatitis, which commonly occurs when there is blocked outflow of pancreatic secretions alcohol poisoning. The complement system, activated during episodes of acute pancreatitis, may lead to embolization of clumped granulocytes, which can travel to the retinal circulation and potentially produce the Purtscher flecken classically seen with Purtscher’s retinopathy. These typically bilateral and polygonal patches of retinal whitening are often associated with significant retinal hemorrhaging. Hemorrhages predominantly are flameshaped, dot, or blot, but can also be pre-retinal as well. Other possible clinical findings include venous dilation, arteriole attenuation, and optic disk swelling. The retinopathy typically resolves within 1-3 months regardless of etiology and treatment. Possible persistent ocular sequelae include optic disk pallor, retinal pigment epithelium changes, and/or attenuation of arteries. Decreased bilateral visual acuity, ranging from mild loss to hand movement, can be accompanied by central, paracentral, or arcuate pattern visual field loss.