A Unique Case of Bilateral Valsalva Retinopathy

Madanagopalan, V G; Velis, Girish

doi:10.18502/jovr.v14i4.5471

Cited by 4 publications

(6 citation statements)

References 4 publications

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“…Although bilateral preretinal hemorrhage has not been reported in KFD, it has been reported in autoimmune hemolytic anemia, 33 Dengue fever, 34 kala-azar, 35 Terson syndrome, 36 , 37 laser in situ keratomileusis (LASIK), 38 aplastic anemia 39 (due to various etiologies, including seronegative hepatitis, 40 chemotherapy and immunosuppressive drugs), 37 , 41 , 42 valsalva retinopathy (usually unilaterally and associated with trauma or exertion, which our patient did not have), 43 shaken baby syndrome, and other forms of child abuse. 44 Our patient's laboratory tests, medical history, and clinical presentations ruled out these potential diagnoses as well as infectious retinitis.…”

Section: Discussionmentioning

confidence: 52%

Bilateral preretinal hemorrhage associated with Kikuchi-Fujimoto disease

Akhavanrezayat

Cooper

Hassan

et al. 2021

American Journal of Ophthalmology Case Reports

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Purpose To present a case of a patient with human immunodeficiency virus (HIV) disease and Kikuchi-Fujimoto disease (KFD) who presented with a unique pattern of retinopathy. Observations A 7-year-old Taiwanese girl with HIV disease who was recently diagnosed with KFD had a sudden onset of blurry vision in both eyes one month after her KFD systemic symptoms had relatively resolved. Ophthalmic examination showed decreased visual acuity in both eyes (OU). On fundus examination, she had bilateral preretinal, subhyaloid, and vitreous hemorrhage that was more severe than anemic retinopathy. Conclusion Ocular manifestations in Kikuchi-Fujimoto disease are rare; however, if they occur, presentations may vary. The exact etiology of the disease has remained elusive and controversial. This case is the first report of a patient with HIV disease and KFD presenting with ocular involvement. Furthermore, bilateral preretinal, subhyaloid, and vitreous hemorrhage, which was beyond anemic retinopathy, is an unprecedented manifestation of KFD that has not been previously reported. This case highlights the necessity for clinicians to consider all possible differential diagnoses when evaluating patients with similar findings to identify the best therapeutic approach and avoid unnecessary treatment.

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Section: Discussionmentioning

confidence: 52%

Bilateral preretinal hemorrhage associated with Kikuchi-Fujimoto disease

Akhavanrezayat

Cooper

Hassan

et al. 2021

American Journal of Ophthalmology Case Reports

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“… 2 Additionally, there are multiple reports of Purtscher-like retinopathy developing after extreme Valsalva, such as weightlifting, and reports of vision loss after a bowel movement, such as from Valsalva retinopathy or acute retinal venous dilation. 3 , 4 , 5 , 6 Here we present a case of Purtscher-like retinopathy following a bowel movement, which to our knowledge has not been previously reported in the literature.…”

Section: Introductionmentioning

confidence: 71%

Purtscher-like retinopathy following a bowel movement

Sokol

Castillejos

Sobrin

2022

American Journal of Ophthalmology Case Reports

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“…8 In acute anemia, retinal hemorrhages appear because of retinal vasodilation caused by relative retinal ischemia from acute blood loss. 3 The level of anemia plays a role in the likelihood of retinal abnormalities seen on fundus examination. In a case series by Carraro et al, 9 the prevalence of retinal abnormalities was 28.3% in anemic patients and 42% in patients with concomitant anemia and thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

“…Valsalva retinopathy was first described in 1972 by Duane 1 and typically presents as a subhyaloid or sub-inner limiting membrane premacular hemorrhage. 3 There have been reports of Valsalva retinopathy presenting as intraretinal or vitreous hemorrhages, Roth spots, or dilated and tortuous retinal veins. 4,5 A Valsalva maneuver increases the intrathoracic pressure, which decreases the venous return to the heart, resulting in decreased stroke volume in the heart.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Bilateral Valsalva Retinopathy in an Acutely Anemic Patient

Castillo

2021

Optom Vis Sci

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SIGNIFICANCE:The Valsalva maneuver is known to cause pre-retinal hemorrhages, which have a predilection to affect the macula. Certain conditions may increase the risk of developing Valsalva retinopathy including anemia. Knowing these associations can aid in uncovering underlying systemic conditions for which a patient may not otherwise be aware. PURPOSE: This case report reviews the presentation of Valsalva retinopathy and the impacts of acute anemia on retinal findings. Recommendations for management are also reviewed and reported.CASE REPORT: A 30-year-old Hispanic man presented to the emergency department for progressing weakness over the previous month. He had a history of polysubstance abuse and had not been eating for the previous month except for water intake. He was diagnosed with unconjugated hyperbilirubinemia, anemia, thrombocytopenia, hypercoagulable state, hypokalemia, and hypomagnesia and admitted to the intensive care unit for treatment and observation. He was referred to the eye clinic to be examined for Kayser-Fleischer rings because of concern for Wilson disease. On ophthalmological examination, the patient had reduced vision in both eyes attributed to bilateral subinternal limiting membrane macular hemorrhages likely due to Valsalva, with acute anemia and thrombocytopenia as contributing factors. The patient was referred to a retinal specialist, and observation was recommended with follow-up in 3 months. The patient, unfortunately, never followed up despite multiple attempts to reschedule.CONCLUSIONS: Patient history and the common location of retinal hemorrhages aid in diagnosing Valsalva retinopathy. In this case, the patient had a known history of acute anemia and thrombocytopenia with a recent history of straining. Anemia, among other systemic conditions, can increase the risk of developing retinopathy after a Valsalva maneuver. Although Valsalva retinopathy can occur in healthy patients without underlying conditions, it is important to rule out other conditions that might present with retinal hemorrhage or that may increase the risk of Valsalva retinopathy.

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A Unique Case of Bilateral Valsalva Retinopathy

Abstract: This is a Photo Essay and does not have an abstract.

Cited by 4 publications

References 4 publications

Bilateral preretinal hemorrhage associated with Kikuchi-Fujimoto disease

Bilateral preretinal hemorrhage associated with Kikuchi-Fujimoto disease

Purtscher-like retinopathy following a bowel movement

Case Report: Bilateral Valsalva Retinopathy in an Acutely Anemic Patient

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