What Is Valsalva Retinopathy?

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Valsalva retinopathy is bleeding from the small blood vessels usually in or near the macula, which is located at the center of the retina. This is the part of your eye that detects light and colors.

This condition occurs following a sudden and often non-serious rise in venous blood pressure, which is caused by an increase in pressure in the chest or abdominal cavities. It typically affects healthy eyes and usually resolves on its own.

eye exam

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Valsalva Retinopathy Symptoms

In Valsalva retinopathy, the sudden increase in pressure in the chest and abdomen can rupture the small blood vessels in the retina. The bleeding from the rupture of the blood vessels is usually under the macula’s internal limiting membrane.

Bleeding into the vitreous, the gel-like fluid that fills your eye, and under the retina can also occur.

Valsalva retinopathy typically affects only one eye. Symptoms of valsalva retinopathy can include:

People with this condition may have different symptoms depending on the severity and location of the bleeding, but they don’t usually experience pain.

Causes

The Valsalva maneuver is a breathing technique that can be used to unclog ears, restore heart rhythm, or diagnose a problem in the autonomic nervous system, which regulates unconscious bodily functions like breathing heartbeat. It is performed by closing your mouth and pinching your nose while breathing out.

While helpful, this maneuver can increase the pressure in your chest and abdomen and cause Valsalva retinopathy.

Certain daily actions can have a similar effect to the Valsalva maneuver and cause Valsalva retinopathy, including:

  • Coughing
  • Vomiting
  • Violent sneezing
  • Lifting, especially while holding your breath
  • Straining while having a bowel movement
  • End-stage labor
  • Blowing into musical instruments

Diagnosis

An eye specialist, such as an optometrist or ophthalmologist, can diagnose a Valsalva retinopathy using a slit lamp, a microscope with a bright light. It helps them evaluate the anterior segment and the fundus of the eye.

The anterior segment of the eye is typically normal, and bleeding in your conjunctiva, a layer of clear tissue that covers the white part of your eye, is rarely seen. Examination of the fundus, the inside, back surface of the eye, typically shows bleeding behind the retina, usually under the macula.

Imaging tests an eye specialist may perform to diagnose Valsalva retinopathy include:

Treatment

Valsalva retinopathy typically resolves on its own without any medical interventions. It usually resolves within weeks to months, depending on how much bleeding is occurring in the eye.

During recovery, people affected by Valsalva retinopathy should avoid strenuous physical activity or using medications that could make the bleeding worse, such as blood thinners.

Prognosis

Prognosis for a person affected with Valsalva retinopathy is good. Typically, complete recovery to baseline visual acuity is expected.

Summary

Valsalva retinopathy is bleeding that results from the rupture of small blood vessels, usually in the macula area. This bleeding can extend to the vitreous or under the retina. It occurs following a sudden increase in the pressure in your stomach or chest after physical exertion that has similar effects to the Valsalva maneuver.

A Word From Verywell

Sudden changes to vision, such as decrease in visual acuity or seeing blurry spots in peripheral vision, should be evaluated quickly by an eye specialist, such as an optometrist or ophthalmologist. The good news is that Valsalva retinopathy typically resolves on its own quickly and your vision will return to normal within weeks or months.

Frequently Asked Questions

  • How does coughing or vomiting cause a Valsalva hemorrhage?

    Certain activities, such as vomiting, coughing, lifting, or straining to have a bowel movement, result in a person holding their breath. The combination of breath holding and physical exertion reduces the return of blood to the heart. This leads to a rise in the pressure throughout the body. Areas of the upper body tend to be affected more often, and this sudden rise in pressure can cause the small blood vessels in the eye to rupture and leak blood, most likely in and around the macula.

  • Are there other treatment options for Valsalva hemorrhage?

    Generally, a person affected by Valsalva retinopathy is monitored by an eye specialist, such as an optometrist or ophthalmologist, since most cases of Valsalva retinopathy resolve on their own.

    If you have a lot of bleeding or the Valsalva retinopathy in the only functioning eye, laser surgery is an option. It allows the blood to drain into the back of the vitreous, which can promote faster healing. However, significant potential complications, such as a macular hole or retinal detachment, can permanently affect vision.

  • Is Valsalva retinopathy hereditary?

    No, there is nothing to indicate that Valsalva retinopathy is hereditary.

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2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Ophthalmology. Valsalva retinopathy. Updated June 17, 2021.

  2. Simakurthy S, Tripathy K. Valsalva retinopathy. StatPearls. Updated August 21, 2021.