Valsalva Retinopathy Workup

Updated: Jan 13, 2023
  • Author: Charles W Eifrig, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Laboratory Studies

Laboratory 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


Imaging Studies

Serial retinal photography can be used to monitor the progression and the resolution of retinal hemorrhages over time.

Retinal fluorescein angiography (FA) can be used to rule out choroidal or retinal neovascularization. Fluorescein angiography also can help identify retinal ischemia or other vasculopathic conditions not associated with Valsalva retinopathy. Finally, angiography can help localize the hemorrhage.

If blood in the vitreous is obstructing the view of the retina, B-scan ultrasonography can be used to rule out a retinal break, tumor, or retinal detachment as cause of the vitreous hemorrhage.

Optical coherence tomography (OCT) can be used to better localize the perimacular or premacular hemorrhage (eg, subhyaloid, sub–internal limiting membrane). [8]


Other Tests

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


Histologic Findings

Preretinal hemorrhages often are located just under the internal limiting membrane and on the surface of the nerve fiber layer. Vitreous hemorrhage and subhyaloid hemorrhage can be seen in this condition. The hemorrhage tends to arise from the superficial capillary bed. As the hemorrhage resolves over time, the blood typically settles at the inferior aspect of the internal limiting membrane 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 typically is unaffected.

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