Unilateral Purtscher-like retinopathy in a soldier patient with prolonged military exertion: A case report

Introduction: Purtscher-like retinopathy is a rare occlusive microvasculopathy that resembles Purtscher retinopathy but occurs without direct trauma. Although it is classically associated with systemic conditions such as pancreatitis, renal failure, and autoimmune disease, exertional and compressive triggers may also be implicated. Case Report: We report a case of unilateral Purtscher-like retinopathy in a healthy soldier in his early 20s who developed sudden, painless decreased vision in the left eye following prolonged military exertion while carrying a heavy weapon over the left chest. Examination revealed optic disc hyperemia, Purtscher flecken, cotton wool spots, and a pseudo-cherry-red spot. Optical coherence tomography demonstrated inner retinal thickening and hyperreflectivity suggestive of inner retinal ischemic involvement. Systemic evaluation was unremarkable, and fluorescein angiography was not performed. The patient was managed conservatively, with near-complete anatomical resolution and improvement of visual acuity from 20/60 to 20/25 at two months. Conclusion: Purtscher-like retinopathy should be considered in young patients presenting with acute visual symptoms after strenuous exertion or sustained thoracic compression. Conservative management with close follow-up may be appropriate in selected cases without systemic disease or severe macular involvement.