Handstand induced visual loss: Valsalva retinopathy.

To cite: Oliphant H, Holmes C, Hassan A, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2014-206733 DESCRIPTION We present a case of a 32-year-old man who presented with a history of right-sided sudden visual loss, approximately 6 h following an intense workout session in the gymnasium. The patient had a history of having had refractive eye surgery approximately 18 months prior in both eyes. After completing a session of ‘push-ups’ in a handstand position, the patient subsequently developed a sudden visual loss in the right eye. On presentation to the hospital eye service, he demonstrated visual acuity of 6/18 in the right eye, and vision of 6/5 in the left. The anterior segment was within normal limits, with no relative afferent papillary defect. Dilated funduscopy revealed a large pre-retinal macular haemorrhage and several scattered intraretinal haemorrahages (figure 1). A diagnosis of Valsalva retinopathy was made, and based on patient preference a decision was made to manage conservatively. Valsalva retinopathy was first described in 1972, being a premacular haemorrhage following exhalation against a closed glottis. This results in a sudden rise in intrathoracic pressure, which in turn leads to rupture of peri-foveal capillaries, giving the classic appearance demonstrated in figure 1. Valsalva retinopathy can often be managed conservatively, achieving favourable visual outcomes. Alternative management strategies can involve Nd:YAG laser to the posterior hyaloid, or vitrectomy.