BACKGROUND: The vasalva maneuver may cause retinal or vitreous hemorrhage due to a rapid rise in venous pressure. There are no valves in the venous system between the heart and the eye, so pressure waves are transmitted to the eye unchecked. The same retinopathy can result from a sudden compressive injury to the chest or abdomen.
Striae within the internal limiting membrane (ILM) are common, but the retinopathy is characterized by hemorrhages that dissect under the ILM. Vitreous hemorrhage results when blood dissects through the ILM. The patient will notice a decrease in vision if the macula is directly affected by retinal hemorrhages or blocked by vitreous hemorrhage. Vision usually returns to normal as the hemorrhage resolves with no residual retinal damage seen.
Terson described a similar appearing retinopathy associated with subarachnoid hemorrhage. A sudden intracranial hemorrhage can result in an increase in retinal venous pressure and retinal and vitreous hemorrhage as describe above. Blood seen around the optic disc can result from blood in the subarachnoid space dissecting through the optic nerve sheath. Vision usually returns to normal with some possible residual retinal pigmentary changes. A subarachnoid hemorrhage can be life-threatening, must be addressed if suspected with a full neurological work-up.
CASE REPORT(S). The case of a 17YO female is presented here. She had given birth the week before, and now complained of a decrease of vision is her right eye for 3 days, along with a severe headache of similar duration. There were striae in the ILM, along with a vitreous hemorrhage overlying the optic disc and inferotemporal arcade.The tentative diagnosis of vasalva retinopathy was made, which can result when a woman holds her breath and strains during childbirth. However, Terson''''s syndrome had to be ruled out due to the complaint of severe headache.
CONCLUSIONS. The neurological exam was normal, so the diagnosis of vasalva retinopathy stood. The patient's vision eventually returned to normal.