Valsalva Case Study

This 19-year-old woman complained that something was blocking her vision in the left eye. She noticed a spot covering her central vision after being assaulted followed by long episodes of sobbing heavily. She did not recall getting hit in the eye during her assault. Her visual acuity in the right was 20/20 and the left was CF at 3 feet. Intraocular pressures were normal with 15 in both eyes. Confrontation field was full to finger count in both eyes, the left had paracentral scotoma superiorly. The pupils were equally round and reactive to light. The slit lamp exam was all normal. The fundus exam was normal in the right eye, while the left eye showed a peripapillary hemorrhage nasally (teal arrows) and a premacular hemorrhage and retinal fold superior. (blue arrow). The patient was reassured this would clear and asked to return to clinic in 3 weeks. At the 3 week follow up, no change was noted in the premacular hemorrhage. She was informed that a vitrectomy could be performed to remove the blood, but she chose to wait for the blood to clear on its own.