Purtscher-like Retinopathy Associated with High Altitude Travel

Purpose To report a case of Purtscher-like retinopathy associated with travel at high altitude. Methods Case report. Results A 67-year-old man presented 2 weeks after acute vision loss in his left eye that occurred while he was hiking in the mountains of South America. Funduscopic examination revealed multiple cotton-wool spots and discrete areas of retinal whitening. Fluorescein angiography demonstrated areas of choroidal fluorescence blocked by retinal whitening, delayed arteriovenous transit time, and late capillary leakage. Spectral-domain optical coherence tomography showed hyperreflectivity in the inner plexiform, inner nuclear, and outer plexiform layers localized to the areas of retinal whitening. These findings were believed to be most consistent with Purtscher flecken, and the patient was diagnosed with Purtscher-like retinopathy. Conclusions Purtscher-like retinopathy may be linked to travel at high altitude through retinal vessel dilation and constriction leading to retinal vasospasm and precapillary arteriole occlusion. This proposed mechanism of pathogenesis suggests that Purtscher-like retinopathy may represent a partial central retinal artery occlusion.