Suprachoroidal hemorrhage following a Valsalva maneuver

In a Valsalva maneuver, a sudden increase in venous pressure may lead to vessel-wall rupture by an apparently excessive pressure gradient across the vessel wall. Thus, various types of periocular hemorrhages have been reported, ie, conjunctival, vitreous, retinal, and orbital.
To our knowledge, the choroidal vessels have not been reported to be a source of bleeding following a Valsalva manever. This is surprising because choroidal hemorrhage, a dreaded complication during and following ocular surgery and trauma, is also caused by an apparently excessive pressure gradient across the vessel wall, in this instance due to hypotonia. We present a case in which a Valsalva maneuver caused a choroidal hemorrhage.