This 40YO male developed sudden loss of vision in his left eye after sneezing 4 days earlier. Vision was 20/1200 OS.
Fundus imaging shows a large sub-internal limiting membrane (ILM) hemorrhage covering the left macula. There is a rim of surrounding nerve fiber layer vs Henle’s blood.
He underwent a YAG laser hyaloidotomy on the same day with immediate improvement to 20/60. Final follow-up vision was 20/30 at 8 weeks.
Learning Points:
Valsalva hemorrhages are usually in the sub-ILM space. 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.
