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Handstand induced visual loss: Valsalva retinopathy
  1. Huw Oliphant,
  2. Christopher Holmes,
  3. Ali Hassan,
  4. Paul Baddeley
  1. Department of Ophthalmology, Worthing Hospital, Worthing, West Sussex, UK
  1. Correspondence to Dr Huw Oliphant, oliphanthe{at}live.com

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Description

We present a case of a 32-year-old man who presented with a history of right-sided sudden visual loss, approximately 6 h following an intense workout session in the gymnasium. The patient had a history of having had refractive eye surgery approximately 18 months prior in both eyes. After completing a session of ‘push-ups’ in a handstand position, the patient subsequently developed a sudden visual loss in the right eye.

On presentation to the hospital eye service, he demonstrated visual acuity of 6/18 in the right eye, and vision of 6/5 in the left. The anterior segment was within normal limits, with no relative afferent papillary defect. Dilated funduscopy revealed a large pre-retinal macular haemorrhage and several scattered intraretinal haemorrahages (figure 1). A diagnosis of Valsalva retinopathy was made, and based on patient preference a decision was made to manage conservatively.

Figure 1

Right fundus photograph, demonstrating Valsalva retinopathy. Large premacular haemorrhage and scattered intraretinal haemorrhages.

Valsalva retinopathy was first described in 1972, being a premacular haemorrhage following exhalation against a closed glottis.1 This results in a sudden rise in intrathoracic pressure, which in turn leads to rupture of peri-foveal capillaries, giving the classic appearance demonstrated in figure 1. Valsalva retinopathy can often be managed conservatively, achieving favourable visual outcomes. Alternative management strategies can involve Nd:YAG laser to the posterior hyaloid, or vitrectomy.2

Learning points

  • To the best of our knowledge, this exact mechanism of developing Valsalva retinopathy has not previously been described.

  • With ‘boot-camp’ style training sessions becoming ever more popular, it is a diagnosis non-specialists should consider following an intense physical exertion followed by sudden visual loss.

  • Multiple management options are available, but ultimately conservative treatment will result in favourable visual outcome.

Acknowledgments

The authors acknowledge Kevin Harrison for the retinal photograph.

References

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Footnotes

  • Contributors HO came up with the idea for the manuscript, and was written in conjunction with AH and CH. PB was the supervising consultant.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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