Medical Retina & the Posterior Segment:
                         Case 23

This 34 year-old male weight-lifter presented to the casualty with a sudden onset left visual loss. He had no medical history of note and blood tests and physical examination was normal.

a. What is the most likely diagnosis?

Valsalva's retinopathy*.

The picture shows the presence of blood underneath the internal limiting membrane in the macular area with subhyaloid haemorrhage (note the fluid level).

b. What is the mechanism of this condition?
Valsalva's retinopathy is caused by ruptures of retinal vessel associated with physical exertion. A sudden and rapid rise in intrathoracic pressure against a closed glottis (as occurring in lifting, straining at stool, coughing or vomiting) causes a rise in intravenous pressure within the eye resulting in rupture of the superficial retinal capillaries.
c. What is the prognosis of this condition?
The vision usually return to normal when the blood is reabsorbed. In cases where the blood is persistent vitrectomy may be needed.
* Antonio Maria Valsalva (1666 - 1723) Italian anatomist. Graduated at Bologna in 1687, he succeeded Malpighi as Professor of Anatomy at the same school. Morgagni was one of his students.
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