Trauma-Induced Purtscher Retinopathy in a 12-Year-Old Child: A Rare Pediatric Case Following Severe Thoracic Injury

Trauma-Induced Purtscher Retinopathy in a 12-Year-Old Child: A Rare Pediatric Case Following Severe Thoracic Injury | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Trauma-Induced Purtscher Retinopathy in a 12-Year-Old Child: A Rare Pediatric Case Following Severe Thoracic Injury Hamza Benmoussa, Mohamed El barkani, Chaimae Khodriss, Meriem El bahloul This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9204091/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Purtscher retinopathy is a rare retinal disorder characterized by sudden vision loss due to microvascular occlusion. It is exceptionally uncommon in the pediatric population. Case presentation We report the case of a 12-year-old boy presenting with severe vision loss in the right eye following polytrauma. Ophthalmologic examination revealed visual acuity limited to counting fingers at 1 meter. Fundus examination showed areas of ischemic retinal whitening in the posterior pole, associated with retinal hemorrhages and cotton-wool spots. Optical coherence tomography demonstrated inner retinal hyperreflectivity. Conclusion This case highlights the importance of recognizing this rare entity in children and emphasizes the need for thorough investigation of the underlying cause, as it may be associated with severe systemic conditions or, in some cases, child abuse, both of which may be life-threatening. Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Purtscher retinopathy is a rare retinal microangiopathy classically associated with severe trauma, particularly involving the head or thorax ( 1 , 2 ). It is characterized by sudden visual loss accompanied by distinctive fundus findings, including cotton-wool spots, retinal hemorrhages, and Purtscher flecken ( 1 , 2 ). The underlying pathophysiology is thought to involve microvascular occlusion due to complement activation, leukocyte aggregation, or embolic phenomena ( 1 , 2 ). While this condition has been mainly described in adults, its occurrence in the pediatric population remains exceptional, with only a limited number of cases reported in the literature ( 3 , 4 ). We report a rare case of Purtscher retinopathy in a child following severe thoracic trauma. CASE PRESENTATION Upon presentation, the patient reported sudden, painless visual loss in the right eye. Best-corrected visual acuity was limited to counting fingers at 1 meter in the right eye, while the left eye was strictly normal with an acuity of 12/10 and no fundus abnormalities. Ophthalmologic examination revealed periorbital ecchymosis with a characteristic “raccoon eye” appearance and subconjunctival hemorrhage, consistent with blunt trauma (Fig. 1 ). Areas of ischemic retinal whitening were observed in the posterior pole, associated with retinal hemorrhages and cotton-wool spots (Fig. 2 ). Optical coherence tomography (OCT) demonstrated inner retinal hyperreflectivity, consistent with ischemic involvement of the inner retinal layers (Fig. 3 ). Ophthalmologic examination of the right eye revealed: Areas of ischemic retinal whitening in the posterior pole Retinal hemorrhages Cotton-wool spots ( 1 , 2 ) Optical coherence tomography (OCT) demonstrated inner retinal hyperreflectivity, consistent with ischemic involvement of the inner retinal layers ( 1 , 2 ). Given the severely reduced visual acuity and the extent of ischemic retinal edema, treatment with high-dose intravenous corticosteroids (methylprednisolone 10 mg/kg) was initiated. Follow-up examination showed resolution of the ischemic retinal edema and hemorrhages; however, there was no recovery of visual acuity in the affected eye ( 3 , 4 ). Written informed consent for publication was obtained from the patient’s parent/legal guardian. DISCUSSION Purtscher retinopathy is a rare retinal microangiopathy first described in adults following severe trauma ( 5 ). It is characterized by sudden visual loss, cotton-wool spots, retinal hemorrhages, and Purtscher flecken on fundus examination ( 1 , 2 ). The pathophysiology is thought to involve microvascular occlusion secondary to emboli, complement activation, or leukocyte aggregation, leading to ischemic injury of the inner retinal layers ( 1 , 2 ). While most reported cases occur in adults, pediatric presentations are extremely uncommon. Only a limited number of pediatric cases have been reported, often associated with trauma, hemolytic uremic syndrome, or nephrotic syndrome ( 3 , 4 ). Our patient represents a rare example of trauma-induced Purtscher retinopathy in a child, triggered by a high-impact thoracic and cranial injury. The clinical features in our patient were typical: sudden unilateral visual loss, ischemic retinal whitening, retinal hemorrhages, and cotton-wool spots ( 1 , 2 ). Optical coherence tomography confirmed inner retinal hyperreflectivity, consistent with ischemic damage. The contralateral eye was strictly normal, highlighting the unilateral nature often seen in pediatric trauma-related cases ( 3 , 4 ). Management remains debated, as there is no standardized therapy. High-dose corticosteroids have been used in selected cases with extensive ischemia and severe visual impairment. Some pediatric reports have demonstrated improvement in retinal edema and visual outcome with intravenous corticosteroid therapy ( 6 ). However, the evidence is inconsistent, and spontaneous recovery has also been described ( 6 , 3 , 4 ). In our patient, 3 days of high-dose intravenous methylprednisolone (10 mg/kg) led to complete resolution of retinal edema and hemorrhages, but visual acuity did not recover, consistent with prior reports showing that structural damage to the inner retina may result in permanent visual loss even after anatomic resolution ( 3 , 4 , 6 ). Adjunctive therapies such as hyperbaric oxygen therapy (HBOT) have been reported in select cases. A case of Purtscher retinopathy secondary to chest injury showed visual and fundus improvement after multiple sessions of HBOT ( 7 ), and a pediatric case combining Purtscher-like retinopathy with other retinal pathology responded favorably to HBOT as a rescue treatment ( 8 ). These interventions remain experimental but highlight potential options for severe or refractory cases. This case underscores several important points for clinicians: Early recognition is crucial. Children may not articulate visual symptoms clearly, and fundus examination should be considered in any pediatric patient with severe thoracic trauma ( 1 , 3 ). Purtscher retinopathy may signal systemic severity. Underlying injuries (such as diaphragmatic hernia in our patient) or even possible child abuse must be considered ( 3 , 4 ). Prognosis is variable. Retinal edema and hemorrhages can resolve spontaneously or with corticosteroid therapy, but visual recovery is unpredictable, especially when ischemic injury is extensive ( 1 , 2 , 3 , 6 ). Literature context. Pediatric cases remain rare, and each new report contributes to understanding the spectrum, mechanisms, and outcomes of the disease in children ( 3 , 4 , 6 , 7 , 8 ). CONCLUSION This case highlights the rare occurrence of Purtscher retinopathy in the pediatric population following severe thoracic trauma ( 3 , 4 ). Clinicians should maintain a high index of suspicion for this condition in children presenting with sudden visual loss after trauma, as early recognition can guide systemic evaluation and management ( 1 , 3 ). Although anatomic resolution of retinal edema and hemorrhages may occur, visual prognosis remains guarded, emphasizing the need for prompt ophthalmologic assessment and close follow-up ( 3 , 4 ). Reporting such cases contributes to the understanding of pediatric Purtscher retinopathy and may help optimize diagnostic and therapeutic strategies in this vulnerable population. Declarations Ethics approval and consent to participate Not applicable. According to local regulations, ethical approval is not required for case reports. Consent for publication Written informed consent for publication of this case report and any accompanying images was obtained from the patient’s legal guardian. Availability of data and materials All data generated or analyzed during this study are included in this published article. Additional details are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This research received no external funding. Author Contribution Author Contributions:H.B. (H. Benmoussa) examined the patient in consultation, collected clinical data, and wrote the first draft of the manuscript.M.E.B. (M. El Barkani) performed ophthalmologic investigations, assisted in drafting the manuscript, and contributed to critical revisions.C.K. (C. Khodriss) contributed to data collection, assisted in the literature review, and participated in manuscript preparation.M.E.Bh. (M. El Bahloul) supervised the case management, performed the literature review, and revised the manuscript for important intellectual content.All authors reviewed and approved the final manuscript. References Agrawal A, McKibbin M. Purtscher’s and Purtscher-like retinopathies: a review. Surv Ophthalmol. 2006;51(2):129–136. Miguel AI, Henriques F, Azevedo LF, Loureiro AJ, Maberley DA. Purtscher’s retinopathy: epidemiology, clinical features and outcomes. Ophthalmologica. 2007;221(4):253–257. Chang MA, Handa JT, Murphy M. Purtscher-like retinopathy in a pediatric patient. J AAPOS. 2018;22(3):228–230. Reddy S, Rani PK, Shetty BK. Traumatic Purtscher-like retinopathy in children: case report and review of literature. BMC Ophthalmol. 2021;21:132. Purtscher O. Angiopathia retinae traumatica. Ber Dtsch Ophthalmol Ges. 1910;36:294–305. Alhamad DM, AlGhamdi AN, AlOtaibi BS. Bilateral combined central retinal artery and vein occlusion in a child with Purtscher retinopathy: a case report and review of the literature. Middle East Afr J Ophthalmol. 2024;30(4):274–280. Lin YC, Yang CM, Lin CL. Hyperbaric oxygen treatment in Purtscher’s retinopathy induced by chest injury. J Chin Med Assoc. 2006;69(9):444–448. Lee CT, Hsieh TH, Chu CC, et al. Hyperbaric oxygen therapy as rescue therapy for pediatric frosted branch angiitis with Purtscher-like retinopathy: a case report. Front Med. 2023;10:1119623. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9204091","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":618627617,"identity":"33247558-6d0d-44da-a920-8d6deee027cf","order_by":0,"name":"Hamza Benmoussa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIiWNgGAWjYBACAwh1AC4gBxExsGBgbyBSi7EBAzNIXIKB5wA2DVi0JG4Aa2HArcWc/XTyhx8Md+TMxQ4fk/zxxy59O3v/0Q0/CoBapLHrsezJ3WDYw/DM2HJ2Wpo0b1ty7s6ew2w3e0AO40vA7rADuRsSeBgOJ264nWMmzdjAnLvhRjLbDR6gFnseHH45/3bDwT8Mh+tBWoAOq083AGq5+QdkCy4tN3I3NgNtSTAAapHgYQMygFpu8+DV8nYzswzDM8MNt9OSrXnbjhtuOHPY7LaMgQQPTi3nczd/fMNwR97gdvLBmz/+VMsbHG98dvPNHxs5XFrAgPEfFkF8GkbBKBgFo2AUEAAAfxBfrFWQ7AAAAAAASUVORK5CYII=","orcid":"","institution":"Abdelmalek Essaâdi University; University Hospital of Tangier","correspondingAuthor":true,"prefix":"","firstName":"Hamza","middleName":"","lastName":"Benmoussa","suffix":""},{"id":618627618,"identity":"7839ed8c-fa68-4860-b66b-3707c5205f7f","order_by":1,"name":"Mohamed El barkani","email":"","orcid":"","institution":"Abdelmalek Essaâdi University; University Hospital of Tangier","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"El","lastName":"barkani","suffix":""},{"id":618627619,"identity":"cd476cc5-efc7-40ab-a527-76bf1096757e","order_by":2,"name":"Chaimae Khodriss","email":"","orcid":"","institution":"Abdelmalek Essaâdi University; University Hospital of Tangier","correspondingAuthor":false,"prefix":"","firstName":"Chaimae","middleName":"","lastName":"Khodriss","suffix":""},{"id":618627620,"identity":"0201f922-b184-4169-aac4-c5154359ba79","order_by":3,"name":"Meriem El bahloul","email":"","orcid":"","institution":"Abdelmalek Essaâdi University; University Hospital of Tangier","correspondingAuthor":false,"prefix":"","firstName":"Meriem","middleName":"El","lastName":"bahloul","suffix":""}],"badges":[],"createdAt":"2026-03-23 19:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9204091/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9204091/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106541650,"identity":"1edb1591-53d7-4a7b-86fe-6ee762b902dc","added_by":"auto","created_at":"2026-04-09 16:10:51","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":137639,"visible":true,"origin":"","legend":"\u003cp\u003ePeriorbital ecchymosis with subconjunctival hemorrhage in the right eye of the patient. Note the characteristic “raccoon eye” appearance, consistent with blunt trauma.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9204091/v1/1d15b2884998ba37e44da160.jpeg"},{"id":106541638,"identity":"ffb9e32b-ab50-4bca-b9cf-152419c66f6d","added_by":"auto","created_at":"2026-04-09 16:10:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":907224,"visible":true,"origin":"","legend":"\u003cp\u003eColor fundus photograph of the right eye showing areas of ischemic retinal whitening in the posterior pole, associated retinal hemorrhages, and cotton-wool spots. These findings are characteristic of Purtscher retinopathy.\u003c/p\u003e","description":"","filename":"F2.png","url":"https://assets-eu.researchsquare.com/files/rs-9204091/v1/901f50fa4d362e4189af3be0.png"},{"id":106541640,"identity":"cc4220cf-c515-4c9c-ae76-3062b74879ae","added_by":"auto","created_at":"2026-04-09 16:10:48","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":824073,"visible":true,"origin":"","legend":"\u003cp\u003eOptical coherence tomography (OCT) scan of the right eye demonstrating inner retinal hyperreflectivity and disruption consistent with ischemic injury. Note the localized retinal edema and structural changes of the inner retinal layers.\u003c/p\u003e","description":"","filename":"F3.png","url":"https://assets-eu.researchsquare.com/files/rs-9204091/v1/292eea37f4bf83be2d99ca3f.png"},{"id":108493788,"identity":"6824aabc-f7e9-4ba1-b638-3b2d8b86e548","added_by":"auto","created_at":"2026-05-05 10:01:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2552330,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9204091/v1/3bf06a51-8149-404a-866f-c4e6e8274b42.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trauma-Induced Purtscher Retinopathy in a 12-Year-Old Child: A Rare Pediatric Case Following Severe Thoracic Injury","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePurtscher retinopathy is a rare retinal microangiopathy classically associated with severe trauma, particularly involving the head or thorax (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It is characterized by sudden visual loss accompanied by distinctive fundus findings, including cotton-wool spots, retinal hemorrhages, and Purtscher flecken (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe underlying pathophysiology is thought to involve microvascular occlusion due to complement activation, leukocyte aggregation, or embolic phenomena (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile this condition has been mainly described in adults, its occurrence in the pediatric population remains exceptional, with only a limited number of cases reported in the literature (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe report a rare case of Purtscher retinopathy in a child following severe thoracic trauma.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eUpon presentation, the patient reported sudden, painless visual loss in the right eye. Best-corrected visual acuity was limited to counting fingers at 1 meter in the right eye, while the left eye was strictly normal with an acuity of 12/10 and no fundus abnormalities. Ophthalmologic examination revealed periorbital ecchymosis with a characteristic \u0026ldquo;raccoon eye\u0026rdquo; appearance and subconjunctival hemorrhage, consistent with blunt trauma (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Areas of ischemic retinal whitening were observed in the posterior pole, associated with retinal hemorrhages and cotton-wool spots (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Optical coherence tomography (OCT) demonstrated inner retinal hyperreflectivity, consistent with ischemic involvement of the inner retinal layers (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOphthalmologic examination of the right eye revealed:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAreas of ischemic retinal whitening in the posterior pole\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRetinal hemorrhages\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCotton-wool spots (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eOptical coherence tomography (OCT) demonstrated inner retinal hyperreflectivity, consistent with ischemic involvement of the inner retinal layers (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the severely reduced visual acuity and the extent of ischemic retinal edema, treatment with high-dose intravenous corticosteroids (methylprednisolone 10 mg/kg) was initiated.\u003c/p\u003e \u003cp\u003eFollow-up examination showed resolution of the ischemic retinal edema and hemorrhages; however, there was no recovery of visual acuity in the affected eye (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Written informed consent for publication was obtained from the patient\u0026rsquo;s parent/legal guardian.\u003c/p\u003e "},{"header":"DISCUSSION","content":"\u003cp\u003ePurtscher retinopathy is a rare retinal microangiopathy first described in adults following severe trauma (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). It is characterized by sudden visual loss, cotton-wool spots, retinal hemorrhages, and Purtscher flecken on fundus examination (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The pathophysiology is thought to involve microvascular occlusion secondary to emboli, complement activation, or leukocyte aggregation, leading to ischemic injury of the inner retinal layers (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile most reported cases occur in adults, pediatric presentations are extremely uncommon. Only a limited number of pediatric cases have been reported, often associated with trauma, hemolytic uremic syndrome, or nephrotic syndrome (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Our patient represents a rare example of trauma-induced Purtscher retinopathy in a child, triggered by a high-impact thoracic and cranial injury.\u003c/p\u003e \u003cp\u003eThe clinical features in our patient were typical: sudden unilateral visual loss, ischemic retinal whitening, retinal hemorrhages, and cotton-wool spots (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Optical coherence tomography confirmed inner retinal hyperreflectivity, consistent with ischemic damage. The contralateral eye was strictly normal, highlighting the unilateral nature often seen in pediatric trauma-related cases (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eManagement remains debated, as there is no standardized therapy. High-dose corticosteroids have been used in selected cases with extensive ischemia and severe visual impairment. Some pediatric reports have demonstrated improvement in retinal edema and visual outcome with intravenous corticosteroid therapy (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, the evidence is inconsistent, and spontaneous recovery has also been described (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In our patient, 3 days of high-dose intravenous methylprednisolone (10 mg/kg) led to complete resolution of retinal edema and hemorrhages, but visual acuity did not recover, consistent with prior reports showing that structural damage to the inner retina may result in permanent visual loss even after anatomic resolution (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdjunctive therapies such as hyperbaric oxygen therapy (HBOT) have been reported in select cases. A case of Purtscher retinopathy secondary to chest injury showed visual and fundus improvement after multiple sessions of HBOT (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), and a pediatric case combining Purtscher-like retinopathy with other retinal pathology responded favorably to HBOT as a rescue treatment (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These interventions remain experimental but highlight potential options for severe or refractory cases.\u003c/p\u003e \u003cp\u003eThis case underscores several important points for clinicians:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEarly recognition is crucial. Children may not articulate visual symptoms clearly, and fundus examination should be considered in any pediatric patient with severe thoracic trauma (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePurtscher retinopathy may signal systemic severity. Underlying injuries (such as diaphragmatic hernia in our patient) or even possible child abuse must be considered (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePrognosis is variable. Retinal edema and hemorrhages can resolve spontaneously or with corticosteroid therapy, but visual recovery is unpredictable, especially when ischemic injury is extensive (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eLiterature context. Pediatric cases remain rare, and each new report contributes to understanding the spectrum, mechanisms, and outcomes of the disease in children (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis case highlights the rare occurrence of Purtscher retinopathy in the pediatric population following severe thoracic trauma (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Clinicians should maintain a high index of suspicion for this condition in children presenting with sudden visual loss after trauma, as early recognition can guide systemic evaluation and management (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Although anatomic resolution of retinal edema and hemorrhages may occur, visual prognosis remains guarded, emphasizing the need for prompt ophthalmologic assessment and close follow-up (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Reporting such cases contributes to the understanding of pediatric Purtscher retinopathy and may help optimize diagnostic and therapeutic strategies in this vulnerable population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. According to local regulations, ethical approval is not required for case reports.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication of this case report and any accompanying images was obtained from the patient\u0026rsquo;s legal guardian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article. Additional details are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contributions:H.B. (H. Benmoussa) examined the patient in consultation, collected clinical data, and wrote the first draft of the manuscript.M.E.B. (M. El Barkani) performed ophthalmologic investigations, assisted in drafting the manuscript, and contributed to critical revisions.C.K. (C. Khodriss) contributed to data collection, assisted in the literature review, and participated in manuscript preparation.M.E.Bh. (M. El Bahloul) supervised the case management, performed the literature review, and revised the manuscript for important intellectual content.All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eAgrawal A, McKibbin M. Purtscher\u0026rsquo;s and Purtscher-like retinopathies: a review. Surv Ophthalmol. 2006;51(2):129\u0026ndash;136.\u003c/li\u003e\n \u003cli\u003eMiguel AI, Henriques F, Azevedo LF, Loureiro AJ, Maberley DA. Purtscher\u0026rsquo;s retinopathy: epidemiology, clinical features and outcomes. Ophthalmologica. 2007;221(4):253\u0026ndash;257.\u003c/li\u003e\n \u003cli\u003eChang MA, Handa JT, Murphy M. Purtscher-like retinopathy in a pediatric patient. J AAPOS. 2018;22(3):228\u0026ndash;230.\u003c/li\u003e\n \u003cli\u003eReddy S, Rani PK, Shetty BK. Traumatic Purtscher-like retinopathy in children: case report and review of literature. BMC Ophthalmol. 2021;21:132.\u003c/li\u003e\n \u003cli\u003ePurtscher O. Angiopathia retinae traumatica. Ber Dtsch Ophthalmol Ges. 1910;36:294\u0026ndash;305.\u003c/li\u003e\n \u003cli\u003eAlhamad DM, AlGhamdi AN, AlOtaibi BS. Bilateral combined central retinal artery and vein occlusion in a child with Purtscher retinopathy: a case report and review of the literature. Middle East Afr J Ophthalmol. 2024;30(4):274\u0026ndash;280.\u003c/li\u003e\n \u003cli\u003eLin YC, Yang CM, Lin CL. Hyperbaric oxygen treatment in Purtscher\u0026rsquo;s retinopathy induced by chest injury. J Chin Med Assoc. 2006;69(9):444\u0026ndash;448.\u003c/li\u003e\n \u003cli\u003eLee CT, Hsieh TH, Chu CC, et al. Hyperbaric oxygen therapy as rescue therapy for pediatric frosted branch angiitis with Purtscher-like retinopathy: a case report. Front Med. 2023;10:1119623.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9204091/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9204091/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePurtscher retinopathy is a rare retinal disorder characterized by sudden vision loss due to microvascular occlusion. It is exceptionally uncommon in the pediatric population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe report the case of a 12-year-old boy presenting with severe vision loss in the right eye following polytrauma. Ophthalmologic examination revealed visual acuity limited to counting fingers at 1 meter. Fundus examination showed areas of ischemic retinal whitening in the posterior pole, associated with retinal hemorrhages and cotton-wool spots. Optical coherence tomography demonstrated inner retinal hyperreflectivity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case highlights the importance of recognizing this rare entity in children and emphasizes the need for thorough investigation of the underlying cause, as it may be associated with severe systemic conditions or, in some cases, child abuse, both of which may be life-threatening.\u003c/p\u003e","manuscriptTitle":"Trauma-Induced Purtscher Retinopathy in a 12-Year-Old Child: A Rare Pediatric Case Following Severe Thoracic Injury","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-09 16:09:04","doi":"10.21203/rs.3.rs-9204091/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"46856787-6e5a-49bc-9dfa-fe7d664bdb10","owner":[],"postedDate":"April 9th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-05T06:01:03+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T06:10:46+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-09 16:09:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9204091","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9204091","identity":"rs-9204091","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}