Valsalva retinopathy

Valsalva retinopathy is a form of retinopathy due to retinal bleeding secondary to rupture of retinal vessels caused by intrathoracic or intra-abdominal pressure due to physical activities.

Valsalva retinopathy
SpecialtyOphthalmology, Optometry
ComplicationsVitreous hemorrhage
CausesIntrathoracic or intra-abdominal pressure, Valsalva manoeuvre[1]
Diagnostic methodOphthalmoscopy

Pathophysiology

Valsalva retinopathy is a form of sub-retinal, sub-hyaloid or sub-internal limiting membrane hemorrhage occur due to rupture of retinal vessels caused by a strenuous physical activity.[1] Physical exertion like weight lifting and aerobic exercise, coughing, sneezing, straining at stool, vomiting, sexual intercourse, pregnancy,[2] asthma,[3] blowing up balloons, blowing musical instruments, cardiopulmonary resuscitation or compression injuries may cause sudden increase in intrathoracic or intra-abdominal pressure may lead to rupture of superficial retinal blood vessels.[4] A sudden increase in venous pressure due to intrathoracic or intra-abdominal pressure cause the small perifoveal capillaries of retina to rupture, leading to premacular hemorrhage of varying intensity.[5]

Signs and symptoms

The main symptom of valsalva retinopathy is painless sudden loss of vision.[6] Sudden-onset floaters and central or paracentral visual field defects and nausea resulting from increased intraocular pressure are other symptoms.[1][3][7]

Diagnosis

Patients may have a history of sudden vision loss after a strenuous physical activity. Physical examination and eye examination is needed for diagnosis of valsalava retinopathy. OCT scanning can be used to identify the location of the bleeding.[4]

Complications

One of the main complications of valsalva retinopathy is vitreous hemorrhage.[5]

Epidemiology

As of 2022, there is currently no specific age, gender or racial preference noted for this retinopathy in the medical literature.[6]

Treatment

Depending on the location and extent of the bleeding, valsalva retinopathy usually resolves within weeks to months, without any complications.[4] Patients are instructed to avoid anticoagulant drugs and physical activities which cause increase in intrathoracic or intra-abdominal pressure.[4] For a speedy recovery, sometimes Nd:YAG laser or argon laser membranotomy may be advised.[8]

History

Valsalva retinopathy was first described in 1972 by American ophthalmologist Thomas D. Duane.[4]

References
  1. Rajshri, Hirawat; Krishnappa, Nagesha C.; Sharma, Unnatti; Ganne, Pratyusha (1 March 2021). "Long-standing Valsalva retinopathy". BMJ Case Reports. 14 (3): e240812. doi:10.1136/bcr-2020-240812. ISSN 1757-790X. PMC 7938996. PMID 33674301. S2CID 232129854.
  2. Al-Mujaini, Abdullah S.; Montana, Carolina C. (7 April 2008). "Valsalva retinopathy in pregnancy: a case report". Journal of Medical Case Reports. 2 (1): 101. doi:10.1186/1752-1947-2-101. ISSN 1752-1947. PMC 2311321. PMID 18394189. S2CID 10134512.
  3. "Valsalva Retinopathy: Vision loss after asthma attack".
  4. "Valsalva Retinopathy - EyeWiki". eyewiki.aao.org. Retrieved 2022-04-24.
  5. Salmon JF (13 December 2019). "Retinal vascular disease". Kanski's clinical ophthalmology : a systematic approach (9th ed.). Elsevier. p. 549. ISBN 978-0-7020-7711-1.
  6. Simakurthy, Sriram; Tripathy, Koushik (2022-02-21). "Valsalva Retinopathy". StatPearls. PMID 31424803.
  7. "Ocular Manifestations Of Valsalva Maneuver". Clinical and Refractive Optometry.
  8. Ophthalmology (Fifth ed.). Edinburgh: Elsevier. 2019. p. 681. ISBN 978-0-323-52820-7.
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