A 28-year-old male presented with sudden onset of blurred vision in both eyes after 2 days of hospitalization for severe epigastric pain and vomiting. He binged 1 L of alcohol 3 days back and had no previous history of binge drinking of significant past medical history. Visual acuity was counting fingers in both eyes. Fundus examination findings are shown below.
What is the most likely cause and mechanism of this patient’s intraocular hemorrhage?
A. Purtscher-like retinopathy; occlusion of arteriolar capillaries
B. Purtscher-like retinopathy; increased intraocular venous pressure
C. Terson retinopathy; increased intraocular venous pressure
D. Terson retinopathy; occlusion of arteriolar capillaries
Correct Answer: A
Purtscher-like retinopathy is a complication of acute pancreatitis and presents as sudden loss of vision. It may also be associated with SLE, amniotic fluid embolisms, and long bone fractures. It is an occlusive process (A) occurring within the arterial side of the peripapillary vascular bed in which complement activation leads to leukoembolization that causes occlusion of small retinal arterioles. Typical fundus findings of Purtscher flecken can help in the diagnosis (as shown in the associated image). Purtscher flecken have sharply demarcated borders and are different than cotton-wool spots, which have indistinct borders (like puffs of cotton wool) and obscure vessels running through them.
Terson retinopathy (C) is caused by an acute rise in intraocular venous pressure that produces backpressure in the capillary and arteriolar beds, causing some of these vessels to rupture. It is more likely to occur following an abrupt intracranial (subarachnoid/subdural) hemorrhage. It is not caused by an occlusion of the arteriolar capillaries (D).
Source: https://www.aao.org/Assets/3325f669-67b9-4ef4-9723-c49396c308fd/637153836909470000/r41u-pdf?inline=1
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