This 28YO male noted sudden vision loss in his left eye 1 day earlier, immediately following coughing. Vision was 20/20 in his normal right eye and counting fingers in his left eye.
Color imaging shows a large layered sub-internal limiting membrane (ILM) hemorrhage occupying the entire macula. The blood extends inferiorly in the subhyaloid space. Some peripapillary vitreous hemorrhage is also noted.
Our patient elected to be observed and, unfortunately, was subsequently lost to follow-up.
Learning Points:
Valsalva retinopathy is characterized by usually unilateral retinal and preretinal hemorrhages caused by raised intrathoracic or intra-abdominal pressure. Various causes include coughing, heavy lifting, and vomiting.
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.
