Purtscher Retinopathy
Purtscher retinopathy can occur following acute compressive injuries to the head, chest, or abdomen, as well as fractures of long bones caused by events such as car accidents, earthquakes, or building collapses. This condition may affect one or both eyes and result in visual impairment. Cotton-wool spots, hemorrhages, and edema are commonly observed around the retina and optic disc, along with optic disc edema or vitreous hemorrhage. Retinal hemorrhages are often distributed around the macula, while cotton-wool spots from fat emboli are generally smaller and located in more peripheral areas. Fluorescein angiography may show small arterial occlusions and leakage, accompanied by eyelid and conjunctival hyperemia, edema, and proptosis. The underlying mechanism is thought to involve the activation of the complement system due to severe systemic tissue damage, granulocyte aggregation, and leukocyte embolization. Local injury to retinal blood vessels may result in complement-mediated leukocyte aggregation and vascular blockage.
Although Purtscher retinopathy is specifically associated with trauma, similar retinal changes may occur in the absence of trauma in other conditions that activate the complement system. Such changes are referred to as "Purtscher-like retinopathy." Examples include acute pancreatitis, connective tissue diseases such as systemic lupus erythematosus, or childbirth.
Terson Syndrome
Terson syndrome refers to hemorrhages that occur within the vitreous body, behind the vitreous, or beneath the internal limiting membrane due to acute intracranial hemorrhage, most commonly subarachnoid hemorrhage. The exact mechanism remains unclear, but it is thought to involve a sudden increase in intraocular venous pressure, causing rupture of peripapillary and retinal blood vessels. Approximately two-thirds of cases of subarachnoid hemorrhage are accompanied by intraocular hemorrhages, with around 6% involving vitreous hemorrhage. Retinal detachment is rare. Terson syndrome can occur at any age but is most commonly observed in individuals aged 30 to 50 years. Early detection and, if necessary, vitreoretinal surgery may improve patient outcomes.
Valsalva Retinopathy
Valsalva retinopathy refers to retinal hemorrhages resulting from a sudden increase in intra-abdominal pressure, caused by activities such as coughing, vomiting, weightlifting, or straining during defecation. The increase in ocular venous pressure can be sufficient to rupture capillaries in the macula, leading to sub-internal limiting membrane hemorrhages. These hemorrhages are typically small, occasionally measuring 1–2 disc diameters, and result in a reduction of visual acuity. The hemorrhages usually resolve spontaneously within several months, and the prognosis is generally favorable.