Valsalva Retinopathy

Dr Ben Wild

Overview

Our vision comes from light waves stimulating retinal photoreceptors and these photoreceptors transferring their signals through a multitude of other cells in the retina to the ganglion nerve cells, then the optic nerve, then to the brain. To help keep these photoreceptors healthy, there are 2 sources of blood flow. One is behind the eye located in the choroid and the other is inside the eye either resting on or inside the retina. Both of these sources represent very strong blood vessels that help create the blood-retinal barrier.

A sagittal view of a healthy eye.

The Valsalva maneuver occurs when the body blocks or restricts the release of an exhale despite the inner muscles contracting to exhale. This leads to increased abdominal and thoracic (chest) pressure. This phenomenon occurs when someone is lifting something heavy, blowing balloons (resistance from balloons blocking full exhale), having a difficult time on the toilet, vomiting, heavy sneezing, etc.

Valsalva retinopathy occurs when the pressure build up is so great that it pops a blood vessel on or inside the retina. This can cause a large pool of blood on the retina or in the vitreous humor (clear gel inside the eye).

A sagittal view of an eye with a vitreous hemorrhage (many tiny red blood cells) and a pre-retinal hemorrhage (larger pool of blood at the back of the eye).

Signs and Symptoms

Signs

Hemorrhage (pool of blood) on the retina or blood cells floating inside the vitreous humor.

Symptoms

Sudden blurry vision, many small orange/red floaters, large dark spot in vision.

Causes and Risk Factors

Causes

Increased abdominal and thoracic pressure leading to increased blood pressure in the head and a popped blood vessel.

Risk Factors

Physical strain: lifting heavy objects, constipation, vomiting, heavy sneezing, blowing balloons, etc.

Prevention and Treatment

Prevention

Avoid strenuous activities.

Treatments

· Monitor since the blood will be re-absorbed on its own.

· In cases where the blood is encapsulated by a thick membrane, a laser can be used to pop the membrane.

Prognosis

Full return to normal vision is almost guaranteed. This may take a week or a few months.