Branch retinal vein occlusion and Valsalva manoeuvre in wind instrument players and singers.

Abstract

Clinical relevance: There are many recognised risk factors for retinal vein occlusions. It is plausible that musicians who play wind instruments or use their voice as their primary instrument may be at increased risk of branch retinal vein occlusions through repeated Valsalva manoeuvre.

Background: Repeated valsalva manoeuvres are commonly performed by musicians using high resistance wind instruments. This also true for singers. This case series illustrates a correlation between repeated Valsalva manoeuvres and retinal vein occlusion in three patients and explores the clinical and functional underlying mechanisms.

Methods: A retrospective review of three cases presenting to a private Ophthalmology clinic.

Results: Case 1 is an 85-year-old male, French Horn player and Case 2 is a 77-year-old male, bass-baritone singer each presented with a left-sided non-ischaemic branch retinal vein occlusion. Case 3 is a 79-year-old male Tenor presented with a left -sided ischaemic branch retinal vein occlusion. All cases were treated with intravitreal anti-vascular endothelial growth factor stabilising vision.

Conclusion: Repeated Valsalva manoeuvre as demonstrated in wind musicians and singers may play a role in pathogenies of branch retinal vein occlusions in susceptible individuals.