Spontaneous suprachoroidal haemorrhage following a valsalva manoeuvre

MAIN Sir, Suprachoroidal haemorrhage is the accumulation of blood within the suprachoroidal space, which is a potential space situated between the choroid and the sclera.1 It has been

reported to occur in all types of intra-ocular procedures.2 Sudden hypotony is thought to be responsible for the haemorrhage.2 We describe a patient who developed a small SCH apparently

induced by a valsalva manoeuvre. CASE REPORT A 65-year-old gentleman presented to the eye casualty, after straining severely during a bowel movement. He felt a sudden ‘popping’ in his right

eye followed by pain and reduced vision in the right eye. There was no past or family history of eye disorders. He was known to be asthmatic and had recently developed a well-differentiated

prostatic cancer that was being treated with Indoramin (a selective alpha-blocker). There was no history of bleeding disorder; routine coagulation screening test results were normal. On

examination, the best corrected visual acuity was 6/24 in his right eye and 6/5 in his left eye. Intraocular pressures were 38 mmHg on the right and 12 mmHg on the left. There was epithelial

oedema affecting the lower half of the right cornea. The anterior chambers were deep and clear and both angles were open. Fundus examination of the left eye revealed an elevated, dark-brown

choroidal mass, approximately five disc diameters in size, located in the inferior half of the fundus (Figure 1). A contact ultrasonographic examination of the right eye confirmed the

presence of a choroidal lesion 4 mm in thickness (Figure 2). An intravenous acetazolamide 500 mg stat dose was given and the right intraocular pressure came down to 16 mmHg. One week later

his right cornea cleared and the right visual acuity had improved to 6/5. The swelling had reduced considerably and it had disappeared by the end of the second week. Ultrasound revealed

total resolution of the choroidal haemorrhage. We suggest that he suffered small choroidal haemorrhage caused by valsalva manoeuvre, and this resulted in a sudden increase in intraocular

pressure and subsequent corneal oedema. COMMENT A valsalva manoeuvre results in a rapid rise in intra-thoracic or intra-abdominal pressure against closed glottis. As a result of the absence

of valves in the venous system, this pressure is transmitted to the eye causing vessel wall rupture by an apparently excessive pressure gradient across the vessel wall.3 A spontaneous

suprachoroidal haemorrhage can result in angle closure glaucoma and corneal oedema secondary to forward displacement of the iris–lens diaphragm.5 In our case the angle was open at the time

of examination. Typically, patients experience a sudden onset of severe ocular pain with a subsequent loss of vision. Headache, nausea and vomiting may also accompany the ocular pain.1

Suprachoroidal haemorrhage after valsalva manoeuvre has been reported in patients either on systemic anti-coagulants, treated with streptokinase or in eyes with previous ocular surgery

(scleral buckle).2,3,4,5 To our knowledge, this is the first reported case of spontaneous choroidal haemorrhage in an individual who is not on any anticoagulants or has had no past history

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Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Princess Margaret Hospital, Okus Road, SN14JU, Swindon, UK T Hammam & C Madhavan Authors * T Hammam View author

publications You can also search for this author inPubMed Google Scholar * C Madhavan View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING

AUTHOR Correspondence to T Hammam. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Hammam, T., Madhavan, C. Spontaneous suprachoroidal haemorrhage

following a valsalva manoeuvre. _Eye_ 17, 261–262 (2003). https://doi.org/10.1038/sj.eye.6700298 Download citation * Published: 14 March 2003 * Issue Date: 01 March 2003 * DOI:

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