Retrohyaloidal Macular Hemorrhage Following a Valsalva Manoeuvre: Case Report and Review of Literature

Abstract

A pre-retinal haemorrhage can complicate several pathologies including Valsalva retinopathy. It can cause symptomatic visual disturbances that lead the patient to seek medical attention. We report the case of a 39-year-old patient, with no particular pathological history, who has a sudden drop in visual acuity in her right eye. This symptomatology appeared a few minutes after defecation following constipation. The ophthalmological examination found a corrected visual acuity in the right eye that was quantified by counting the fingers at close range. The fundus revealed a macular haemorrhage suspended in a pigeon's nest. The diagnosis of spontaneous right retrohyaloidal haemorrhage secondary to cephalic venous hyper pressure was retained. A Yag laser membranotomy was performed at a distance from the fovea. The evolution was favourable with an increase in visual acuity to 6/10. The main aetiology of retrohyaloidal haemorrhages is rarely venous cephalic hypertension. However, Valsalva's retinopathy should always be considered in case of effort with chest blockage in inspiration.