This 39YO male presented with a 3-day history of sudden floaters and central scotoma in his left eye following heavy lifting. Vision was 20/20 in his normal right eye and 20/20 OS.
Color fundus imaging shows multi-layered hemorrhages in the posterior pole, including vitreous, subhyaloid, sub-internal limiting membrane (ILM), Henle’s layer, and deep intraretinal or subretinal. The blood spontaneously resolved after 2 weeks of observation.
Learning Points:
Valsalva retinopathy is characterized by pre-retinal blood (classically sub-ILM but also subhyaloid and vitreous) following a Valsalva maneuver (heavy lifting, vomiting, coughing, sneezing, and compression injuries).
The hemorrhages virtually always resolve without sequelae, although the sub-ILM/hyaloid blood can be drained into the inferior vitreous by creating a small opening in the ILM/hyaloid using either a thermal or Nd:YAG laser.
The differential diagnosis includes other conditions causing multi-layered hemorrhages, including ruptured retinal arterial macroaneurysm, trauma, and anemic/leukemic retinopathy.
