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Valsalva Retinopathy Workup

  • Author: Robert S Duszak, OD, FAAO; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Oct 13, 2014
 

Laboratory Studies

See the list below:

  • Lab studies can be used to rule out predisposing risk factors, including diabetes, sickle cell disease, anemia, idiopathic thrombocytopenic purpura, and other blood dyscrasias. Important tests include the following:
    • Complete blood count
    • Fasting blood sugar, glucose tolerance test
    • Prothrombin time, activated partial thromboplastin time
    • Sickle-cell preparation, hemoglobin electrophoresis, antiphospholipid antibodies
    • Urinalysis
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Imaging Studies

See the list below:

  • Retinal photographs can be useful to monitor the progression and the resolution of retinal hemorrhages over time.
  • Retinal fluorescein angiography can be used to determine the location of active leakage if neovascularization is suspected secondary to an underlying medical problem.
  • If blood in the vitreous is obstructing the view of the retina, B-scan ultrasonography can be used to screen for a retinal break or detachment.
  • Optical coherence tomography (OCT) has been used to view the exact location of a premacular hemorrhage (under the internal limiting membrane).[23]
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Other Tests

See the list below:

  • Blood pressure measurement is an essential ancillary test to rule out hypertension as a predisposing risk factor.
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Histologic Findings

Preretinal hemorrhages lie just under the internal limiting membrane and in front of the nerve fiber layer. They arise from the superficial capillary bed. As the hemorrhage resolves over time, the blood typically settles at the bottom of the internal limiting membrane of the retina in a D-shaped pattern. Very specific color changes are associated with resolution: red to yellow and yellow to white. Upon complete resolution of the hemorrhage, retinal function is typically unaffected.

Valsalva retinopathy has a predilection for the macula. The perifoveal capillary bed is presumably targeted because of its detailed structural architecture.

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Contributor Information and Disclosures
Author

Robert S Duszak, OD, FAAO Attending Physician, Philadelphia Veterans Affairs Medical Center; Consulting Staff, Nemours Health Clinic, Mayfair Eye Associates; Adjunct Clinical Faculty, Eye Institute of the Pennsylvania College of Optometry

Robert S Duszak, OD, FAAO is a member of the following medical societies: American Geriatrics Society, American Academy of Optometry, American Optometric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steve Charles, MD Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

V Al Pakalnis, MD, PhD Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, South Carolina Medical Association

Disclosure: Nothing to disclose.

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Initial presentation of a Valsalva retinopathy less than 24 hours following a Valsalva maneuver in an 18-year-old man. Note the large preretinal hemorrhage. Vision was finger counting at 5 feet.
At 4-month follow-up of the same patient as in the image above, most of the large preretinal hemorrhage had cleared with observation alone. Note the wrinkled internal limiting membrane temporal to the macula and the resolving hemorrhage at the edge of the demarcation line of the stretched internal limiting membrane inferiorly. Vision had returned to 20/20.
A large preretinal hemorrhage in a 42-year-old man following a Valsalva maneuver. This image was taken 2 days after he underwent heavy straining while lifting weights.
This 58-year-old man with uncontrolled diabetes presented with complaints of a spot in his vision following straining during a bowel movement. He had active proliferative diabetic retinopathy, and the hemorrhage shown in this image stems from a broken neovascularized blood vessel secondary to a Valsalva maneuver.
 
 
 
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