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Table 1 Perioperative loss of vision in nonocular surgery – common differential diagnoses[1517]

From: Purtscher’s retinopathy after intramedullary nailing of a femoral shaft fracture in a 20-year old healthy female – report of a rare case and review of the literature

Site of injury/location of the lesion causing visual problems Specific location Underlying causes
External ocular injury Corneal abrasion, corneal exposure Perioperative exposure of cornea or microtrauma
Retina (retinal ischemia) Central retinal artery occlusion/occlusion of retinal arterial branch either ischemic or embolic Occurs mainly in cardiac/vascular surgeries (emboli), but also in spinal surgery due to prone positioning (external compression of the globe), very rarely other forms of surgery (e.g. orthopedic surgery)
Purtscher’s can be regarded as a special form of this entity
Ischemic optic neuropathy Anterior ischemic optic neuropathy, posterior optic neuropthay Most common site of permanent injury, most often in spinal surgery (prone position), bilateral involvement in most cases
Lesion of retrochiasmal visual pathways Either homonymous hemianopia (unilateral) or cerebral/cortical visual impairment (bilateral) Most common mechanism: embolic cerebral infarction (posterior cerebral arteries). Mainly in cardiac surgeries, resection of head and neck tumors