Purtscher-like retinopathy following valsalva maneuver effect: case report

A 43-year old Malay man presented with a sudden onset of central foggy vision in the left eye after holding his breath for two minutes while catching a falling object. It was not associated with floaters, flashes of light, or head trauma. His vision in the right eye was 6/6, and in his left eye it was finger counting. He had bilateral temporal sub-conjunctival hemorrhages. An examination of his left fundus revealed multiple white cotton wool spots and dot-blot retinal hemorrhages with diffuse retinal edema at the posterior pole. His right fundus was noted to have only mild temporal peri-papillary edema associated with a few dot-blot hemorrhages. Fundus fluorescein angiography showed good arterial perfusion and no evidence of leaking or neo-vascularization. A diagnosis of Purtscher-like retinopathy was made, and the patient was treated with indomethacin tablets for six weeks. At his six-week follow-up examination, his left eye visual acuity had improved to 6/12. His bilateral sub-conjunctival hemorrhage had resolved. His left fundus showed residual multiple cotton wool spots and reduced retinal edema.Treatment with non-steroidal anti-inflammatory drugs seems to be effective in reducing edema in patients with Purtscher-like retinopathy.Purtscher's retinopathy is a rare condition and is noted in cases associated with various types of trauma, including head trauma, seatbelt and airbag pressure, malar bone fracture, crush injury, and chest trauma [1-4]. The fundus characteristics are Purtscher flecken, which are multiple cotton wool spots of varying sizes. The findings in the fundus in patients with Purtscher-like retinopathy are similar, but without any association with trauma. Herein we report the case of a patient with Purtscher-like retinopathy that occurred after the Valsalva maneuver effect.A 43-year old Malay man presented to our hospital with sudden-onset blurring of the vision, which he described as central foggy vision that occurred after he caught a piece of f