Valsalva Retinopathy

  • Nathalia Corbelli RobertiEmail author
  • Eduardo Büchele Rodrigues
Part of the Retina Atlas book series (RA)


Valsalva retinopathy was firstly described in 1972 by Thomas Duane as a particular form of retinopathy characterized by preretinal bleeding secondary to a sudden increase in intrathoracic pressure (Duane 1972, 1973). Hemorrhage typically occurs in the macular region (Fig. 6.1) and may resolve spontaneously within a few days or take months for complete reabsorption (Gass 1987). It usually affects young adults causing unilateral low visual acuity sudden and painless. Cases of bilateral involvement have been described (Durukan et al. 2008). The prolonged period of contact between the blood and the retina may lead to complications with risk of persistence of impaired visual acuity (Nili AhmadAbadi et al. 2009).


  1. Blaise P, Duchateau E, Comhaire Y, et al. Optical coherence tomography in the diagnosis of premacular hemorrhage. Retina. 2006;26:232–4.CrossRefGoogle Scholar
  2. Chandra P, Azad R, Pal N, et al. Valsalva and Purtscher’s retinopathy with optic neuropathy in compressive thoracic injury. Eye. 2005;19:914–5.CrossRefGoogle Scholar
  3. De Maeyer K, Van Ginderdeuren R, Postelmans L, et al. Sub-inner limiting membrane haemorrhage: causes and treatment with vitrectomy. Br J Ophthalmol. 2007;91(7):869–72.CrossRefGoogle Scholar
  4. Duane TD. Valsalva hemorrhagic retinopathy. Trans Am Ophthalmol Soc. 1972;70:298–313.PubMedPubMedCentralGoogle Scholar
  5. Duane TD. Valsalva hemorrhagic retinopathy. Am J Ophthalmol. 1973;75(4):637–42.CrossRefGoogle Scholar
  6. Durukan AH, Kerimoglu H, Erdurman C, et al. Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to valsalva retinopathy. Eye (Lond). 2008;22(2):214–8.CrossRefGoogle Scholar
  7. Gabel VP, Birngruber R, Gunther-Koszka H, et al. Nd:YAG laser photodisruption of hemorrhagic detachment of the internal limiting membrane. Am J Ophthalmol. 1989;107(1):33–7.CrossRefGoogle Scholar
  8. García Fernández M, Navarro JC, Castaño CG. Long term evolution of valsalva retinopathy: a case series. J Med Case Rep. 2012;6:346.CrossRefGoogle Scholar
  9. Gass JDM. Stereoscopic atlas of macular diseases: diagnosis and treatment. 3rd ed. St Louis: Mosby; 1987.Google Scholar
  10. Gibran SK, Kenawy N, Wong D, et al. Changes in the retinal inner limiting membrane associated with valsalva retinopathy. Br J Ophthalmol. 2007;91(5):701–2.CrossRefGoogle Scholar
  11. Goel N, Kumar V, Seth A, et al. Spectral-domain optical coherence tomography following Nd:YAG laser membranotomy in valsalva retinopathy. Ophthalmic Surg Lasers Imaging. 2011;42:222–8.CrossRefGoogle Scholar
  12. Hasegawa T, Ooto S, Yoshimura N. Spectral domain optical coherence tomography for three dimensional visualization of the detached membrane in valsalva retinopathy. Jpn J Ophthalmol. 2011;55(1):81–3.CrossRefGoogle Scholar
  13. Herr S, Pierce MC, Berger RP, et al. Does valsalva retinopathy occur in infants? An initial investigation in infants with vomiting caused by pyloric stenosis. Pediatrics. 2004;113:1658–61.CrossRefGoogle Scholar
  14. Hesse L, Schmidt J, Kroll P. Management of acute submacular hemorrhage using recombinant tissue plasminogen activator and gas. Graefes Arch Clin Exp Ophthalmol. 1999;237:273–7.CrossRefGoogle Scholar
  15. Jayaprakasam A, Matthew R, Toma M, et al. Valsalva retinopathy in pregnancy: SD-OCT features during and after Nd:YAG laser hyaloidotomy. Ophthalmic Surg Lasers Imaging. 2011;17:42.Google Scholar
  16. Koh HJ, Kim SH, Lee SC, et al. Treatment of subhyaloid haemorrhage with intravitreal tissue plasminogen activator and C3F8 gas injection. Br J Ophthalmol. 2000;84:1329–30.CrossRefGoogle Scholar
  17. Kumar V. Optical coherence tomography changes following vitrectomy for long standing premacular hemorrhage in valsalva retinopathy. Int J Ophthalmol. 2017;10(11):1779–82.PubMedPubMedCentralGoogle Scholar
  18. Kwok AK, Lai TY, Chan NR. Epiretinal membrane formation with internal limiting membrane wrinkling after Nd:YAG laser membranotomy in valsalva retinopathy. Am J Ophthalmol. 2003;136:763–6.CrossRefGoogle Scholar
  19. Ladjimi A, Zaouali S, Messaoud R, et al. Valsalva retinopathy induced by labour. Eur J Ophthalmol. 2002;12:336–8.CrossRefGoogle Scholar
  20. Li N, Zhu Z, Yi G, et al. Valsalva retinopathy in twin-pregnancy: a case report and literature review. Am J Case Rep. 2018;19:5–9.CrossRefGoogle Scholar
  21. Mennel S. Subhyaloidal and macular haemorrhage: localisation and treatment strategies. Br J Ophthalmol. 2007;91(7):850–2.CrossRefGoogle Scholar
  22. Meyer CH, Mennel S, Rodrigues EB, et al. Is the location of valsalva hemorrhages submembranous or subhyaloidal? Am J Ophthalmol. 2006;141:231–2.CrossRefGoogle Scholar
  23. Nili AhmadAbadi M, Karkhaned R, Mirshahi A, et al. Premacular hemorrhage in valsalva retinopathy: a study of 21 cases. Iran J Ophthalmol. 2009;21(3):11–6.Google Scholar
  24. Park SW, Seo MS. Subhyaloid hemorrhage treated with SF6 gas injection. Ophthalmic Surg Lasers Imaging. 2004;35:335–7.CrossRefGoogle Scholar
  25. Rennie CA, Newman DK, Snead MP, et al. Nd:YAG laser treatment for premacular subhyaloid hemorrhage. Eye. 2001;15(Pt 4):519–24.CrossRefGoogle Scholar
  26. Schmitz K, Kreutzer B, Hitzer S, et al. Therapy of subhyaloidal hemorrhage by intravitreal application of rtPA and SF(6) gas. Br J Ophthalmol. 2000;84(11):1324–5.CrossRefGoogle Scholar
  27. Shukla D, Naresh KB, Kim R. Optical coherence tomography findings in valsalva retinopathy. Am J Ophthalmol. 2005;140:134–6.CrossRefGoogle Scholar
  28. Sueke H. Valsalva retinopathy induced by vigorous nightclub dancing. Med J Aust. 2009;190:333.CrossRefGoogle Scholar
  29. Tatlipinar S, Shah SM, Nguyen QD. Optical coherence tomography features of sub-internal limiting membrane hemorrhage and preretinal membrane in valsalva retinopathy. Can J Ophthalmol. 2007;42:129–30.CrossRefGoogle Scholar
  30. Ulbig MW, Mangouritsas G, Rothbacher HH, et al. Long-term results after drainage of premacular subhyaloid hemorrhage into the vitreous with a pulsed Nd:YAG laser. Arch Ophthalmol. 1998;116(11):1465–9.CrossRefGoogle Scholar
  31. Xie ZG, Yu SQ, Chen X, et al. Macular hole secondary to valsalva retinopathy after doing push-up exercise. BMC Ophthalmol. 2014;14:98.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Nathalia Corbelli Roberti
    • 1
    Email author
  • Eduardo Büchele Rodrigues
    • 2
    • 3
  1. 1.Department of OphthalmologySão Paulo Federal UniversitySão PauloBrazil
  2. 2.Department of Ophthalmology and Visual SciencesFederal University of São PauloSão PauloBrazil
  3. 3.Department of OphthalmologySaint Louis University School of MedicineSaint LouisUSA

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