Valsalva Retinopathy in a Young Patient: A Case Report

Valsalva retinopathy (VR) is a rare condition characterized by sudden visual loss due to premacular hemorrhage caused by abrupt increases in intraocular venous pressure during the Valsalva maneuver. It primarily affects healthy young adults during activities such as weightlifting, intense exercises, vomiting, and coughing. Spontaneous hemorrhage resolution may take several months, during which dehemoglobinization occurs gradually through macrophage activity - potentially leading to chronic visual impairment. This case report discusses a 20-year-old male with sudden vision loss in the right eye after weightlifting. Initial visual acuity was counting fingers at 10 cm, with premacular hemorrhage confirmed by ocular ultrasound. Expectant management was initially chosen; however, due to the lack of improvement after 60 days, pars plana vitrectomy (PPV) was performed. Postoperatively, the patient achieved 20/20 visual acuity with no retinal abnormalities. The pathophysiology of VR involves rupture of the perifoveal capillary plexus due to increased intrathoracic pressure. The macular region is prone to hemorrhage due to the lack of firm internal limiting membrane adhesions. While spontaneous resolution is common, large hemorrhages can cause complications such as macular holes, epiretinal membrane formation, and loss of photoreceptors due to the generation of free radicals. Treatment options include laser membranotomy and PPV, with the latter being preferred for dense or persistent hemorrhages. In this case, PPV successfully restored the patient's visual acuity, underscoring the importance of timely surgical intervention when conservative management fails. Early ophthalmologic evaluation and appropriate clinical follow-up remain critical in managing VR and preserving vision.