Optometry Continuing Education

Sudden Visual Loss Following Car Crash

CE credits
 1 hour

COPE code
70566-PS / 120809

Available until
Dec 18, 2023

Access COPE case on Sudden Visual Loss for FREE and learn...

  • the pathophysiology of Purtcher's retinopathy
  • ​the systemic diseases associate with Purtcher's
  • best practices and management for traumatic retinopathy


A 25-year-old woman complained of sudden loss of vision in her right eye immediately following a car accident. She had fractured both femurs and numerous ribs, but had no major facial trauma. Her vision in the affected eye was reduced to the ability to only count fingers.


Ocular trauma can be associated with several findings including globe rupture, hyphema, angle recession, traumatic cataract in the anterior segment; retinal findings, including retinal tear and detachment, retinal “bruising” (called commotio retina and representing photoreceptor outer segment disruption), retinal dialysis (disinsertion of peripheral retina from the underlying choroid), and intraretinal or vitreous hemorrhage can also occur. Trauma distant from the eye, including chest and long-bone fracture, can also be associated with changes in the retina.


In 1910, Otmar Purtscher described bilateral segmental whitening in the retinas of a middle-aged man who fell from a tree and suffered head trauma. Today the term “Purtscher's retinopathy” is used to describe retinal disorders seen after trauma.

Purtscher's and Purtscher's-like Retinopathy (PuR) are rare; collectively, their estimated incidence is 0.24 persons per million per year. Sixty percent of cases present with bilateral involvement.

The findings of Purtscher's and Purtscher's-like retinopathy include cotton wool spots (93% of cases), intraretinal hemorrhages (65%) and Purtcher's Flecken (present in 63% of cases, but thought to be pathognomonic for this condition). Purtscher's Flecken are well-defined white lesions that are separated from precapillary arterioles, arterioles, and venules by a clear 50μm space on either side of the vessel. Cotton-wool spots do not have this clear zone, may be located superficially over the vessels, and are ill-defined.


Step 1: Pathophysiology

Understand the pathophysiology of Putcher's retinopathy

Step 2: Systemic Diseases

Review the systemic diseases associated with Purtcher's

Step 3: Management 

Learn best practice and management for traumatic retinopathy 

Hi, we're Optocase

Since 2006 we've created premium content for over 19,000+ Optometrist so they can continue their education while staying CE compliant - on their terms. 
2021 © Optocase.com and CEHC Inc.