Case Report: Bilateral Valsalva Retinopathy in an Acutely Anemic Patient

Abstract

Significance: The Valsalva maneuver is known to cause pre-retinal hemorrhages, which have a predilection to affect the macula. Certain conditions may increase the risk of developing Valsalva retinopathy including anemia. Knowing these associations can aid in uncovering underlying systemic conditions for which a patient may not otherwise be aware.

Purpose: This case report reviews the presentation of Valsalva retinopathy and the impacts of acute anemia on retinal findings. Recommendations for management are also reviewed and reported.

Case report: A 30-year-old Hispanic man presented to the emergency department for progressing weakness over the previous month. He had a history of polysubstance abuse and had not been eating for the previous month except for water intake. He was diagnosed with unconjugated hyperbilirubinemia, anemia, thrombocytopenia, hypercoagulable state, hypokalemia, and hypomagnesia and admitted to the intensive care unit for treatment and observation. He was referred to the eye clinic to be examined for Kayser-Fleischer rings because of concern for Wilson disease. On ophthalmological examination, the patient had reduced vision in both eyes attributed to bilateral subinternal limiting membrane macular hemorrhages likely due to Valsalva, with acute anemia and thrombocytopenia as contributing factors. The patient was referred to a retinal specialist, and observation was recommended with follow-up in 3 months. The patient, unfortunately, never followed up despite multiple attempts to reschedule.

Conclusions: Patient history and the common location of retinal hemorrhages aid in diagnosing Valsalva retinopathy. In this case, the patient had a known history of acute anemia and thrombocytopenia with a recent history of straining. Anemia, among other systemic conditions, can increase the risk of developing retinopathy after a Valsalva maneuver. Although Valsalva retinopathy can occur in healthy patients without underlying conditions, it is important to rule out other conditions that might present with retinal hemorrhage or that may increase the risk of Valsalva retinopathy.