Monday, August 11, 2008

9.4 Valsalva retinopathy

Lu Ying-Chi of Chinese Taipei won a bronze medal of women's 63kg weightlifting
event at Beijing 2008 Olympic Games, Aug 11, 2008.

Chen Xiexia (C) of China, Sibel Ozkan (L) of Turkey and Chen Wei-Ling (R) of Chinese Taipei wave to spectators at the awarding ceremony of the women's 48kg of weightlifting event at Beijing 2008 Olympic Games at the Beijing University of Aeronautics & Astronautics Gymnasium in Beijing, China, Aug 9, 2008. Chen Xiexia, Sibel Ozkan and Chen Wei-Ling won the gold, silver and bronze medals respectively. (From news/

Weight-lifting can injure the eyes. No kidding.

Once a patient came in and complained that his vision in the right eye was suddenly lost when he tried to lift some heavy boxes in his basement. Valsalva retinal hemorrhage immediately comes to mind. However, fundus exam reveals a cellophane membrane over a "wrinkled" macula. A macular pucker, it turned out to be. This is entirely different from the first suspect which occurs when one holds breath performing physically strenuous tasks, e.g., heavy weight-lifting, giving birth, passing stool, etc. The increase in the intrathoracic/abdominal pressure raises the venous pressure which in turn causes rupture of retinal capillaries. The blood accumulates between the retina and the vitreous. And vision changes if the hemorrhages occur within the visual axis. Often the history and a retinal exam confirm the diagnosis:

(Image from Digital Ophthalmology)

The above is an unusually large pre-retinal hemorrhage in a case of Valsalva retinopathy. More common than not, the hemorrhages are much smaller of about 1 disc diameter often found near the disc itself; although they can extend into the macula and obscure vision.

Luckily, most cases of simple Valsalva retinopathy heal quickly, spontaneously, and completely. Some cases, usually those with pre-existing vascular disorders, may require the Nd:YAG laser/surgical intervention.

So who/why/what is "Valsalva"? Well, Mr Antonio Maria Valsalva (1666-1723) was an Italian physician specializing in ear anatomy. He had also described the (original) Valsalva maneuver (i.e., what happens physiologically when you forcibly exhale against a closed glottis). He also coined the term, the Eustachian tube (which connects the middle ear and the pharynx). When you travel by air, when the airplane descends for landing, your ears tend to "pop". The reason is the rapid increase in the atmospheric pressure causes the Eustachian tube to collapse (or become pinched). Gum-chewing works the best in opening this tube and restoring the pressure balance. If you don't have any chewing gums handy, try opening your jaws with the lips closed instead.