Valsalva retinopathy following brief hanging from a window in a khat user: a case report

BACKGROUND: Valsalva retinopathy is a well-recognized cause of sudden, painless visual loss resulting from preretinal hemorrhage following an abrupt increase in intrathoracic or intra-abdominal pressure. It is most commonly associated with activities such as coughing, vomiting, and physical exertion. CASE PRESENTATION: We report the case of a 23-year-old previously healthy male who presented with acute, painless visual loss in the left eye following khat chewing and brief hanging from a window. Ophthalmic examination revealed a dense premacular hemorrhage associated with marked visual impairment. Optical coherence tomography (OCT) confirmed a subhyaloid hemorrhage, demonstrating a dome-shaped premacular hemorrhagic cavity beneath the posterior hyaloid face. A diagnosis of Valsalva retinopathy was established based on the clinical and imaging findings. The patient underwent Nd laser hyaloidotomy using a Q-switched Nd laser, resulting in successful drainage of the hemorrhage into the vitreous cavity. At one-month follow-up, complete visual recovery (6/6) was achieved, with complete resolution of the hemorrhage and no procedure-related complications. DISCUSSION: This case highlights an uncommon presentation of Valsalva retinopathy following brief hanging from a window. The hanging episode was considered the most likely precipitating event because of its potential to generate substantial Valsalva stress and a sudden increase in retinal venous pressure. Although khat use has not been established as a direct cause of Valsalva retinopathy, its sympathomimetic cardiovascular effects may have contributed to vascular susceptibility. This report expands the spectrum of atypical triggers associated with Valsalva retinopathy. CONCLUSION: Valsalva retinopathy should be considered in young patients presenting with sudden visual loss, even when the precipitating event is unconventional. Early treatment with Nd laser hyaloidotomy can result in excellent anatomical and visual outcomes in selected patients with dense premacular hemorrhage.