This 49YO male presented with 4 days of vision loss in his left eye. He denied any Valsalva maneuver. Vision was 20/25 in his normal OD and 20/20 OS.
Pseudocolor SLO imaging shows a large sub-internal limiting membrane (ILM) hemorrhage, nasal and superior to the nerve, along with scattered mostly deep, white-centered retinal hemorrhages. OCT scanning confirms the sub-ILM blood but also reveals shallow subhyaloid blood. Unfortunately, he was immediately lost to follow up. He then presented 1 month later with a breakthrough vitreous hemorrhage. Vitrectomy was advised due to his prior non-compliance. Vision 1 month postoperatively was 20/20, with complete resolution of all hemorrhages (not shown).
Learning Points:
Valsalva retinopathy, first described by Thomas Duane (Trans Am Ophthalmol Soc 1972; 70:298-313), is characterized by unilateral retinal and preretinal hemorrhages caused by elevated intrathoracic or intra-abdominal pressure. Various causes include coughing, heavy lifting, and vomiting. However, as in our case, patients sometimes present with these findings while denying any Valsalva maneuver. These hemorrhages virtually always resolve without sequelae, although the preretinal blood in severe cases can be drained into the inferior vitreous by creating a small ILM opening using either a thermal or Nd:YAG laser. Non -clearing break through vitreous hemorrhage is treated with vitrectomy.
