A 27-year-old man described a sudden dark reddish blur in the center of his left visual field after moving furniture. He denied any history of ocular disease or trauma. His left visual was counting fingers and intraocular pressure was normal. Ophthalmoscopy showed a fresh and dome-shaped preretinal hemorrhage over the macula ( Fig. 1 A) . Corresponding optical coherence tomography (OCT) revealed a dome-shaped, highly elevated lesion with a hyporeflective area beneath ( Fig. 1 B) . Given the substantial hemorrhage, Nd:YAG laser membranotomy was recommended. However, the patient opted for conservative observation.
Three days later, he reported seeing “reddish fluid flowing down” in the left eye, accompanied by a gradual improvement of his central vision. Ocular examination showed spontaneous drainage of the premacular hemorrhage into the vitreous cavity ( Fig. 1 C) . The patient was asked to maintain a semi-recumbent position. At the ten-day follow-up, the premacular hemorrhage had completely resolved, with a small amount of blood remaining in the inferior vitreous cavity ( Fig. 1 D) . The OCT revealed a cavity structure beneath the internal limiting membrane with a small hyperreflective plague below the original premacular hemorrhage, suspected to be a breach of inner limiting membrane (ILM) ( Fig. 1 E–F) . His visual acuity in the left eye improved to 20/20 and remained stable at the three-month follow-up.
Valsalva retinopathy is an acute, nontraumatic preretinal hemorrhage caused by a sudden increase in intraocular pressure. It typically occurs in young, healthy individuals and can be triggered by actions such as severe coughing, heavy lifting, forceful straining or sneezing, collectively referred to as valsalva maneuvers. While a three-month observation period is acceptable for gradual resolution, early intervention, such as laser membranotomy, can help prevent potential irreversible retinal damage caused by prolonged contact with hemoglobin and iron toxicity. However, potential risks such as macular hole formation, epiretinal membrane and retinal detachment should be considered. Spontaneous drainage of valsalva premacular hemorrhage is rarely reported. In this case, we believe that blood drainage occurred through a small breach in the inferior ILM, induced by the gravitational force of extensive hemorrhage. The hyperreflective plaque observed on OCT indicates either old hemorrhage trapped at the site of the breach or the proliferation of the ILM. The patient is fortunate because the spontaneous drainage minimizes the risks of laser and surgical interventions.
Ethics approval and consent to participate
This study was conducted in compliance with a suitable accredited institutional review board from the Ethics Committee of Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong.
Funding
This work was supported by the Natural Science Foundation of Guangdong Province , China ( 2024A1515012992 ).
Authors’ contributions
DZ collected and analyzed the data. DZ drafted the article and ZH revised it critically. DZ and ZH have read and approved the final manuscript.
Conflicts of interest
The authors claim no conflicts of interests.
Declaration
This work does not utilize large language models.
Consent for publication
Consent for publication has been obtained from the patient.
Competing interests
The authors have no proprietary or commercial interest in any materials discussed in this manuscript.
Acknowledgments
The authors thank the patient for granting permission to publish this information.
References
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