a 17-year - old man presented to us with a chief complaint of the sudden onset of decreased visual acuity , accompanied by central scotoma , which developed in the left eye .
no relevant ophthalmologic history was noted . at the time of initial diagnosis , the corrected visual acuity was 20/20 in the right eye and 20/100 in the left eye .
a slit lamp exam demonstrated no significant findings in the anterior segment including the cornea , anterior chamber , and anterior vitreous body . on fundoscopy
, there was a dumbbell - shaped macular bleed with a well - defined margin in the left eye ( fig .
1 ) . optical coherence tomography demonstrated that a highly reflective shadow was present in the macular area ( fig .
one month after presentation , the patient had an improved uncorrected visual acuity of 20/20 in the right eye and 20/25 in the left eye .
on fundoscopy , the pre - retinal bleeding observed at the time of initial diagnosis had resolved ( fig .
the valsalva maneuver decreases venous return to the heart by exhaling against a closed glottis ; this leads to an increase in abdominal and intrathoracic pressures .
this markedly increases the cardiac output within several minutes , thus increasing arterial pressures.1 the venous system of the head and neck lack a functional valvular system .
therefore , if abdominal or intrathoracic pressures are suddenly raised with a closed glottis , this pressure increase would be directly transferred to the vascular system of the head and neck .
a marked increase in intraocular pressure provokes spontaneous rupture of capillary vessels surrounding the central fossa .
this can result in a loss of visual acuity in otherwise healthy eyes.14 the resulting retinal hemorrhage spontaneously resolves within several weeks to several months in most cases and is not accompanied by notable complications.15 in the current case , retinal bleeding occurred in a 17-year - old man who had no significant past history , immediately following an oratorical contest .
presumably , an excessive amount of oration caused a sudden increase in venous pressure , resulting in valsalva retinopathy .
 a 17-year - old man presented to us with a chief complaint of decreased visual acuity accompanied by central scotoma . 
 there was nothing unusual in his medical history other than a recent oratorical contest . at the time of initial diagnosis , the corrected visual acuity was 20/20 in the right eye and 20/100 in the left eye . 
 no significant findings were apparent on ophthalmic evaluation . 
 on fundoscopy , there was a dumbbell - shaped macular bleed with a well - defined margin in the left eye . 
 the clinical course was closely monitored along with drug therapy . 
 four weeks post presentation , the pre - retinal hemorrhage had nearly resolved . 
 on fluorescein angiography , no significant findings were observed . in the left eye , 
 the corrected visual acuity had improved to 20/25 . 
 valsalva retinopathy is a pathology that occurs when a sudden increase in intra - thoracic pressure or abdominal pressure occurs in an otherwise healthy person . 
 here we report a case of valsalva retinopathy occurring following an oratorical contest along with a review of the relevant literature . 
Case Report
Discussion