June 04, 2026 | Virtual Event
Devarsh Joshi
Basingstoke and North Hampshire Hospital, USA
Devarsh Joshi, is a resident doctor with a special interest in ophthalmology, currently working at Basingstoke and North Hampshire Hospital. He holds two degrees from St George’s University of London, an MBBS and a First- Class Honours BSc in Biomedical Sciences.
Introduction: Retinal haemorrhages are a recognised complication of Valsalva manoeuvres associated with activities such as coughing, heavy lifting and vomiting that cause a sudden rise in intrathoracic pressure. We report a case of intraretinal haemorrhages in a patient with bulimia nervosa and longstanding purging behaviours, highlighting a previously under-recognised ocular complication of an eating disorder.
Method: A 49-year-old woman was referred to the medical retina clinic after retinal haemorrhages were detected during a routine sight test. A detailed clinical history, comprehensive ocular examination and retinal imaging were performed, alongside review of systemic investigations.
Results: The patient reported a five-year history of bulimia nervosa with binge–purge cycles occurring up to three times weekly at their peak, now significantly reduced following psychological therapy. She described episodes of bloodshot eyes after purging but denied visual disturbance, flashes or floaters. She had no significant medical history, did not smoke, and denied heavy lifting, coughing, constipation or trauma. Systemic assessment and blood tests were unremarkable. Visual acuity was 6/6 bilaterally. Dilated fundus examination revealed several small intraretinal haemorrhages along the distal superior vascular arcade in the left eye, with an otherwise normal ocular examination. In the absence of alternative causes, vomiting-induced Valsalva retinopathy was considered the most likely diagnosis. The patient was scheduled for clinical monitoring.
Conclusion: This case demonstrates a novel association between bulimic purging behaviours and retinal haemorrhages. Awareness of this relationship may assist clinicians in identifying underlying eating disorders, broadening differential diagnoses for retinal haemorrhages and supporting collaborative care between ophthalmology and mental health services.
