A sudden rise in intrathoracic or intra-abdominal pressure (eg, as during coughing, vomiting, lifting, or straining for a bowel movement) may increase intraocular venous pressure sufficiently to rupture small superficial capillaries in the macula. The hemorrhage is typically located under the ILM, where it may create a hemorrhagic detachment of the ILM. Vitreous hemorrhage and subretinal hemorrhage may be present. Vision is usually only mildly reduced and the prognosis is excellent, with spontaneous resolution usually occurring within months after onset. The differential diagnosis of Valsalva retinopathy includes posterior vitreous separation, which may cause an identical hemorrhage or a macroaneurysm. Therefore, in all cases, a peripheral retinal tear or an aneurysm along an arteriole must be ruled out.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.