Valsalva Retinopathy
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A 25-year-old woman at 11 weeks of gestation presented with sudden, painless, central “dark” vision after an episode of forceful vomiting (“morning sickness,” or emesis gravidarum). Visual acuity was 20/80 in the left eye. Funduscopy revealed sedimented preretinal hemorrhage that was enclosed by a dome-shaped preretinal membrane, features consistent with Valsalva retinopathy (Panel A). Examination of the right eye was normal, as were the blood pressure, complete blood count, prothrombin time, activated partial-thromboplastin time, and fasting blood glucose level. Improvement was seen at 2 weeks (Panel B), 2 months (Panel C), and 5 months (Panel D) after presentation, and the hemorrhage finally resolved. Visual acuity in the left eye improved to 20/25. Typically self-limiting, Valsalva retinopathy is caused by retinal capillary rupture after abrupt rises in intraocular venous pressure, which may occur with violent coughing or vomiting...

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