Maneuvers for the treatment of eustachian tube dysfunction and Valsalva retinopathy

Author: Carla Arteaga Henriquez (Spain)

Co-authors: Hugo E. Tapia Quijada, Sandra Gomez Perera, Maria Diaz de Aguilar Osona

Purpose

There are numerous etiologies that produce Valsalva retinopathy. This can originate from any situation that produces an increase in retinal venous pressure secondary to a decrease in the usual venous return to the heart can lead to sudden subhialoid hemorrhage. We present the case of a female patient with Valsalva in the context of maneuvers prescribed by her Otolaryngologist for the treatment of Eustachian tube dysfunction presented by the patient.

Setting/Venue

Section Retina. Canary Islands University Hospital. Tenerife-Spain

Methods

Case report

Results

A 23-year-old woman with no medical history presented sudden loss of vision in her left eye (LE). Visual acuity was 1.0 in RE and finger count in LE. Anterior segment was normal. Fundoscopy in LE showed multiple subhyaloid hemorrhages, affecting the macular area in a navicular form. OCT revealed hemorrhage that affected the macular area. Fluorescein angiography showed signs of blockage due to the preretinal hemorrhage. Although the clinical examination suggested Valsalva retinopathy, the patient flatly denied having performed all the known causes of this entity. The complete coagulation study was normal, ruling out blood dyscrasias. The electronic medical record showed the diagnosis of tubal dysfunction, and the Otolaryngologist had indicated as treatment exercises to open the Eustachian tubes. In a directed anamnesis, the patient confirmed that frequently when she felt her ears plugged, she performed the exercises that consisted of inhaling deeply and then exhaling with her mouth and nose closed. This data raised the hypothesis that our patient's Valsalva retinopathy is secondary to the exercises for tubal dysfunction that she performed. At 7 months of expectant conservative attitude there was visual recovery and complete remission of hemorrhages, OCT is normal with a thick posterior hyaloid.

Conlusions

The prescribed maneuvers for the treatment of Eustachian tube dysfunction is an etiology to be taken into account for Valsalva retinopathy.

Financial Disclosure

NO FINANCIAL DISCLOSURES

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