Case of the Month I July 2020

Case of the Month
July 21, 2020

The Case

The patient was a 43-year-old woman with a sudden decrease in vision in the left eye two weeks previously. There had been no subsequent change in vision. The past medical history is remarkable for bronchitis with an acute exacerbation about two weeks ago. The visual acuity was 20/20 OD and 20/50 OS. The examination of the right eye was unremarkable. The left fundus and OCT are shown below. What is the most likely diagnosis? What treatment, if any, would you recommend?

This patient had Valsalva retinopathy, in which a rapid rise in intravenous pressure results in a ruptured superficial retinal blood vessel. This occurs when there is a sudden increase in intrathoracic or intra-abdominal pressure against a closed glottis. Activities that can result in Valsalva retinopathy include lifting, straining during a bowel movement, vomiting, and, as in our case, coughing. Patients can have a vitreous hemorrhage, hemorrhagic detachment of the internal limiting membrane, or a retinal hemorrhage. If the bleeding is in the foveal area, the blood can dissect posteriorly to the deep retinal or subretinal spaces. The OCT of our patient reveals dissection of blood to the mid-retina. Patients generally experience a complete recovery of vision, but this can take weeks or months as the blood is absorbed. Occasionally, vitrectomy is needed.

Case Photos

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This patient had Valsalva retinopathy, in which a rapid rise in intravenous pressure results in a ruptured superficial retinal blood vessel. This occurs when there is a sudden increase in intrathoracic or intra-abdominal pressure against a closed glottis. Activities that can result in Valsalva retinopathy include lifting, straining during a bowel movement, vomiting, and, as in our case, coughing. Patients can have a vitreous hemorrhage, hemorrhagic detachment of the internal limiting membrane, or a retinal hemorrhage. If the bleeding is in the foveal area, the blood can dissect posteriorly to the deep retinal or subretinal spaces. The OCT of our patient reveals dissection of blood to the mid-retina. Patients generally experience a complete recovery of vision, but this can take weeks or months as the blood is absorbed. Occasionally, vitrectomy is needed.

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