High-Altitude-Associated Purtscher-Like Retinopathy: A Diagnostic Dilemma

Purpose: To describe clinical and fundoscopic findings in a patient deployed at a high-altitude region with Purtscher-like retinopathy. A 46-year-old healthy male patient of Asian descent deployed at a high-altitude region (>9000 feet) presented with sudden onset painless diminution of vision in the right eye. The ophthalmic examination and imaging showed a large, confluent patch of retinal whitening involving the macula, superficial hemorrhages, and arteriolar attenuation in the right eye along with grade 4 RAPD which were consistent with Purtscher-like retinopathy. Spectral-domain optical coherence tomography also showed inner retinal thickening in areas of clinically observed retinal whitening. The patient was observed for 2 months. Visual acuity showed no improvement with the resolution of retinal whitening and hemorrhages. There were macular pigmentary changes and optic atrophy in the right eye. An extensive literature review was done, and there is only a single case reported showing high-altitude-associated Purtscher-like retinopathy. Conclusion: Clinicians should be made aware of Purtscher-like retinopathy as a severe ophthalmic complication associated with deployment at high-altitude regions (>9000 feet).