Valsalva retinopathy generally resolves on its own within approximately three months, though some patients may need a pars plana vitrectomy in cases requiring rapid hemorrhage clearance. Photo: Mark T. Dunbar, OD. Click image to enlarge.

Valsalva retinopathy results from a sudden increase in intrathoracic pressure and presents with sudden, painless vision loss. It’s common among weightlifters and may also result from coughing, vomiting or compressive injuries. Researchers recently studied Valsalva retinopathy presentation and management to learn more about the disease and its outcomes. They reported that the condition has a favorable visual prognosis and most cases resolve with observation.

The study included 58 eyes of 58 patients. Overall, 34.4% of Valsalva retinopathy cases resulted from weightlifting, 20.6% from vomiting, 20.6% from straining and 17.2% from coughing. The study group’s mean BCVA at diagnosis was 20/163 and improved to 20/59 at three months, 20/48 at six months and 20/22 at one year. Hemorrhages cleared on clinical exam after an average of 99 days in patients who were observed and in 4.5 days after pars plana vitrectomy.

The researchers reported that the most commonly affected vitreoretinal compartments were the subhyaloid (42.3%), intraretinal (32.7%), intravitreal (23.1%) and subretinal (13.4%) spaces.

“Valsalva-induced hemorrhage frequently resolves quickly with observation,” the researchers wrote in their paper. “Some recommend at least three months of observation while others encourage early intervention to prevent retinal damage by hemosiderin.”

Based on the study findings, the authors added in their paper that “observation is appropriate for most patients while pars plana vitrectomy may be indicated for cases that require prompt resolution of hemorrhage.”