This 61YO healthy female presented with sudden blurred vision immediately following forceful blowing of her nose 3 days earlier. Vision was 20/25 OU.
Optos imaging shows bilateral superior suprachoroidal blood, which extends into the right macula and temporal periphery.
Swept-source OCT through the macula hemorrhage shows hyporeflective suprachoroidal elevation. Observation was recommended, and we expect the blood to absorb over the coming months.
Learning Points:
Valsalva-induced retinal findings almost always present with sub-internal-limiting-membrane blood. Suprachoroidal hemorrhage most commonly develops intra- or postoperatively, following trauma or with thrombolytic agents (Ghu and Green, Survey Ophthalmology 1999;43:471-486).
Valsalva-induced choroidal hemorrhage is exceedingly rare, with only a handful of cases reported in the literature, including a prior Retina Rocks case (see Image Gallery, Valsalva retinopathy folder, Valsalva UIV-20220511).
As with other localized suprachoroidal hemorrhages, these lesions may simulate uveal melanoma (Marous et al, Retina 2018;12:336-341).
