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Transactions on Engineering and Computing Sciences - Vol. 11, No. 4
Publication Date: August 25, 2023
DOI:10.14738/tecs.114.15174.
Constant, S. T. Y., Yves, O., Epiphane, K. B. T., Béda, A. G., Kpatchingnin, K., Zana, D., & Lliane, G. (2023). Bilateral Optic Neuropathy:
What Facts in a Valsalva’s Maneuver Context? A Case Report. Transactions on Engineering and Computing Sciences, 11(4). 117-
123.
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Bilateral Optic Neuropathy: What Facts in a Valsalva’s Maneuver
Context? A Case Report
Sowagnon Thierry Yves Constant
Ophthalmology department of the
Yopougon University Hospital, Abidjan-Côte d'Ivoire
Ouattara Yves
Ophthalmology department of the
Bouaké University Hospital, Abidjan-Côte d'Ivoire
Kouaï Bi Ta Epiphane
Ophthalmology department of the
Yopougon University Hospital, Abidjan-Côte d'Ivoire
Appia Gilles Béda
Ophthalmology department of the
Yopougon University Hospital, Abidjan-Côte d'Ivoire
Koné Kpatchingnin
Ophthalmology department of the
Yopougon University Hospital, Abidjan-Côte d'Ivoire
Diabaté Zana
Ophthalmology department of the
Bouaké University Hospital, Abidjan-Côte d'Ivoire
Godé Lliane
Ophthalmology department of the
Bouaké University Hospital, Abidjan-Côte d'Ivoire
ABSTRACT
Introduction: Repeated Valsalva’s maneuvers can result in severe optic neuropathy.
We describe here, for the first time in the literature, a case of blindness related to
this mechanism. Observation: This was a young autistic man engaged several times
a day in Valsalva’s maneuvers and who presented with a bilateral and rapidly
progressive decrease in visual acuity. The anamnesis, the clinical examination and
the radiological explorations made it possible to make the diagnosis of bilateral
optic neuropathy secondary to these Valsalva’s maneuvers. Discussion: The optic
neuropathy occurring during the Valsalva’s maneuver would be the result of three
associated mechanisms: abnormalities of the orbital vascularization, ischemia and
chronic compression of the optic nerve responsible for an almost total destruction
of the optic nerve and source of blindness.
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Constant, S. T. Y., Yves, O., Epiphane, K. B. T., Béda, A. G., Kpatchingnin, K., Zana, D., & Lliane, G. (2023). Bilateral Optic Neuropathy: What Facts in a
Valsalva’s Maneuver Context? A Case Report. Transactions on Engineering and Computing Sciences, 11(4). 117-123.
URL: http://dx.doi.org/10.14738/tecs.114.15174
RNFL optical coherence tomography (OCT) shows a temporal and superior thinning more
marked on the right; macular OCT is normal in both eyes. Exploration of colour vision reveals a
red-green axis dyschromatopsia; the biological assessment (CBC, BSR and CRP) is normal. We
did not find any genetic mutation or mitochondrial DNA mutations.
A cerebral MRI and an electroencephalogram performed could not show any abnormalities
related to Gilles de la Tourette syndrome.
However, the radiological assessment (orbito-cerebral CT and MRI) found a bilateral bone
defect of the internal wall of the orbit associated with a small tissue intra-orbital and ethmoidal
formation, containing air and taking little the contrast in contact with the bony defect of the
wall of the orbit without apparent compression of the optic nerve (figure 2).
A and B
C and D
Figure 2: 2A Pneumorbit in the form of hypodense vacuoles (white arrows) on CT at the level of
the internal walls with bone defect at the level of the 2 internal walls (red arrows)