This 37YO male presented 1 day after sudden vision loss in his right eye following vigorous coughing. Vision was 20/400 in his right eye and 20/20 in his normal left eye.
Fundus examination of his right eye showed scattered posterior pole retinal hemorrhages and a large sub-internal limiting membrane (ILM) hemorrhage obscuring his right macula.
A Neodymium:YAG laser was used to create a small inferior opening in the ILM. Fundus photography shows that the blood immediately began draining into the inferior vitreous.
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 sub-ILM 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, as was done for this patient.
