Central retinal vein occlusion following Sirsasana (headstand posture)

Abstract

We report a case of central retinal vein occlusion (CRVO) following Sirsasana, a head-down postural yoga. A 55-year-old male patient presented to us, with sudden-onset loss of vision following Sirsasana, in the right eye. The patient had suffered from pulmonary thromboembolism 5 years earlier and was receiving warfarin prophylaxis. Over 6 months of follow-up, the patient developed neovascularization of the iris and was subjected to panretinal laser with no improvement in visual acuity. Sirsasana could be an important risk factor for CRVO especially in predisposed patients.

Adverse Events Associated with Yoga: A Systematic Review of Published Case Reports and Case Series

“…Of the included 37 reports, 19 originated from the USA [28], [31]–[33], [35], [38]–[40], [43]–[47], [49], [52], [55]–[57], [61], 1 from Canada [60], 2 from the UK [51], [59], 1 from Germany [42], 1 from Switzerland [25], 2 from Italy [26], [34], 1 from Denmark [36], 5 from India [29], [41], [48], [53], [54], and 1 each from Nepal [27], China [37], Taiwan [58], South Korea [30], and Australia [50]. The first included report was published in 1969, the number of reports published each year gradually increased until 2012 (Figure 2).…”

“…Regarding specific yoga postures, the headstand (Sirsasana) was practiced in 10 cases [25], [27], [28], [32], [35], [37], [38], [46], [52], [53], the shoulder stand in 3 cases [36], [39], [52], variations of the lotus position (Padmasana) in 3 cases [26], [47], [56], forceful breathing techniques in 3 cases [40], [41], [55], voluntary vomiting (Kunjal Kriya) in 2 cases [27], [48], and postures that included putting 1 or 2 feet behind the head in 2 cases [34], [50]. Kneeling posture (Vajrasana) [31], locust pose (Salabhasana) [36], bridge pose (Setu bandha) [49], seated forward bend (Paschimottasana) [57], and downward-facing dog (Adho mukha savasana) [58] were practiced in 1 case each.…”

“…Another case was reported doing “extreme yoga postures” that were not further characterized [29]. In 10 cases, the yoga practice that was associated with the adverse event was practiced under supervision [26], [42], [43], [45], [51], [54], [56], [58], [59], [61], in 4 cases it was unsupervised [33], [53], [55], [61]. The remaining reports did not state whether the practice was supervised or not.…”

“…Nine cases reported orbital adverse events including acute glaucoma [36], [52], worsening of chronic glaucoma [25], [35], [38], and orbital varices or vein occlusion [32], [46], [49], [53]. Peripheral neuropathy was reported by 4 cases [34], [47], [56], [57], stroke by 3 cases [37], [39], [49], and transient headache by 7 cases [60].…”

Central Retinal Vein Occlusion

“…There are a number of anecdotal case reports of CRVO with many systemic diseases, including acquired immunodefi ciency disease [ 17 -28 ], arteriovenous fi stula of the carotid artery to the cavernous sinus [ 29 -34 ], acute myeloid leukemia [ 35 ], acute retinal necrosis [ 36 ], angle-closure glaucoma, Behçet's disease [ 37 , 38 ], bone marrow transplantation [ 39 ], cannabis smoking [ 40 ], cavernous sinus thrombosis [ 41 , 42 ], Churg-Strauss syndrome [ 43 ], contraceptive pills [ 44 -46 ], cosmetic iris implants [ 47 ], Crohn's disease [ 48 -51 ], cyanotic heart disease [ 52 ], dehydration [ 53 ], Eisenmenger syndrome [ 54 ], essential thrombocythemia [ 55 , 56 ], exercise induced [ 57 ], following cardiac surgery [ 58 ], following pars plana vitrectomy [ 59 ], pseudoexfoliation of the lens capsule [ 60 -63 ], laser in situ keratomileusis [ 64 ], glucose-6-phosphate dehydrogenase defi ciency [ 65 ], headstand posture in Yoga (Sirsasana) [ 66 ], hemodialysis [ 67 ], human herpes virus [ 68 ], high altitude [ 69 , 70 ], hormone replacement therapy [ 71 ], interferon therapy [ 72 -76 ], intraocular nematode [ 77 ], isotretinoin use for acne [ 78 ], Leber's hereditary optic neuropathy [ 79 ], licorice ingestion [ 80 ], malignant arterial hypertension [ 81 ], melanocytoma of the optic disc [ 82 , 83 ], metastatic adenocarcinoma in the optic nerve sheath [ 84 ], migraine [ 85 ], multiple myeloma [ 86 , 87 ], non-Hodgkin's lymphoma [ 88 -90 ], occult colon cancer …”