Purtscher retinopathy is a rare but severe sight-threatening eye condition that mostly occurs in middle-aged men after chest compression or head injury. In cases such as acute pancreatitis, connective tissue disorders, kidney failure or COVID-19 infection with similar ocular findings but no history of trauma, a diagnosis of Purtscher-like retinopathy is made. We present a case of a 72-year-old female with typical symptoms of Purtscher retinopathy in both eyes after a car crash accident. Although the pathophysiology of the disease is not fully understood, the main cause of Purtscher retinopathy seems to be an embolic occlusion of the precapillary arterioles which supply the superficial peripapillary capillaries. Activation of the C5a component of the complement predisposes the leukocytes to aggregation, which obstructs blood flow. The main symptom of Purtscher retinopathy is sudden, painless deterioration of vision which occurs up to 48 h after the injury. In most patients, the changes observed in the fundus of the eye resolve within several months, and visual acuity slowly improves, sometimes even returning to the state from before the injury. However, risk factors such as older age, high hyperopia, and late treatment implementation can make the prognosis less favorable.

Background: The use of preservative agents in eye drop solutions may worsen symptoms of ocular surface disease, which is a highly prevalent syndrome worldwide. Preservatives are often used in pharmacotherapy of glaucoma, another disease concerning tens of millions of people around the globe. These numbers are predicted by the World Health Organization and are predicted to increase with time due to constant aging of populations. Methods: PubMed and Scopus databases were searched for articles investigating the topic of ocular surface disease in relation with glaucoma pharmacotherapy, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The aim of this review is to summarize the effect of various solvents used in drug formulations and ways to quantify their impact on the ocular surface. Discussion and Conclusions: Topical ophthalmic preservative-free formulations are better tolerated and less burdensome for all patients. They should be considered especially for glaucoma patients, who are expected to take medications for years, up to decades or a lifetime in many cases. Due to the chronicity of dry eye disease and the lack of reliable ways for lacrimal and meibomian gland renewal, primary prophylaxis is of uttermost importance. Unfortunately, despite the development of many measuring devices, the standardization of diagnostic methods poses a challenge due to high variability of results which are influenced by a myriad of factors—local, internal, and external.

Visual field defects resulting from compressive or infiltrative lesions in the visual pathway often differ from typical textbook patterns. This results from asymmetric tumor growth or uneven impact of individual nerve fibres, which also differ in their susceptibility to damage. In addition, the reliability of perimetry based on false positive and negative errors on the part of the examined person must be taken into account. Neuroimaging comes in handy with interpretation of doubtful cases. Unfortunately, sometimes the visual field defects can mimic glaucomatous defects, especially in correlation with elevated intraocular pressure as an incidental finding. This delays making the critical diagnosis and proper treatment of the patient. In ophthalmological practice, knowledge of the proliferative processes of the central nervous system, together with the basic characteristics of these diseases, plays a crucial role in the clinical assessment of indications for extended diagnostics.

Altitude is an environmental factor that induces systemic physiological adaptations, many of which extend to the visual system. These changes are multifactorial and stem from fluctuations in atmospheric pressure, varying rates of oxygen deficiency (hypoxia), reduced gravitational forces, and increased exposure to ultraviolet radiation. Notably, environmental pressure differentials below sea level also bear clinical significance. For instance, divers—particularly those engaged in frequent and deep-sea diving—are subject to a unique set of environmental stressors that may predispose them to physiological alterations. Similarly, individuals residing in high-altitude regions exhibit numerous long-term adaptive mechanisms, which have their downsides. Aviation, especially at high altitudes and during high-speed flight, imposes additional visual health risks on pilots and aircrew. Furthermore, spaceflight represents an extreme environmental condition; prolonged exposure to microgravity has been associated with the development of spaceflight-associated neuro-ocular syndrome, a constellation of neuro-ophthalmic changes that are still under active investigation. In all these contexts, the composition of ambient air, including its humidity, temperature, and pollutant content, can significantly impact the ocular surface.

Background: Choroidal rupture with subretinal hemorrhage comprising the fovea is thought to have poor prognosis regardless of surgical interventions. Being a relatively rare entity, managing patients, referring them in time and standardizing a therapeutic approach remains challenging. Many eyecare practitioners opt solely for conservative treatment, without recurring to any surgical treatment. Case Reports: Three young adult males with blunt ocular trauma complicated by choroidal rupture with subretinal hemorrhage presented to the vitreoretinal surgeon appointment. All of them underwent pars plana vitrectomy with subretinal rtPA administration. All patients were then monitored for recovery with conservative treatment and despite the present post traumatic choroidal rupture, they achieved major improvement in visual acuity along with OCT parameters compared to their initial presentation. Conclusion: Not all vitreoretinal surgeons perform subretinal rtPA injection, partly due to not being trained in this aspect, but also due to controversies around this approach. Intravitreal rtPA injection is an easier alternative, although less impactful. Sometimes, even performing a gas endotamponade in the vitreous cavity without specific fibrinolytic treatment can improve results upon blood dislocation away from the fovea. Knowledge on the possibility of surgical intervention in patients with subretinal hemorrhage is important to be popularized among ophthalmologists, so they can refer these cases to vitreoretinal surgeons promptly instead of sticking to conservative treatment only, which may be the inferior choice in cases with macular involvement when time plays a key role.

Background: The aim of the study was to assess retinal circulation in military pilots, as well as to determine the relationship between the type of aircraft, flight altitude, total hours of flight time and parameters of retinal circulation, using OCT angiography (OCT-A). Methods: This cross-sectional study enrolled 44 military pilots and 44 controls. The inclusion criteria encompassed healthy adult men. Due to the fact that military pilots cannot suffer from any vision defects or any other eye disease, the exclusion criteria concerned the control group and included refractive error exceeding −3 diopters (D) and +3 D and concomitant eye diseases, such as any retinal or choroidal pathologies, glaucoma, uveitis. The exclusion criteria for both groups were low-quality OCT-A images. Subsequently, the results of the measurements obtained for 176 eyes were included in further descriptive and multivariate analyses, of which 88 were in the pilot group versus 88 in the comparison group. Results: The total vessel density in superficial and deep capillary plexuses was significantly decreased (p = 0.0176, p < 0.0001, resp.) the longer the flight experience, particularly in the parafoveal region (p = 0.0299 and p < 0.0001, resp.). Moreover, the foveal avascular zone area was significantly increased proportionally to the total hours of flight (p = 0.0083). Also, the total vessel density was increased with a higher flight altitude in the deep capillary plexus (p = 0.0042), especially in the parafoveal region (p = 0.0110). Conclusions: Gravitational forces manifesting in the unique conditions of the flight of military pilots seem to induce microvascular changes in the retina.