Abstract
Spontaneous retinal venous pulsation is seen as a subtle variation in the calibre of the retinal vein(s) as they cross the optic disc. The physical principles behind the venous pulsations has been the point of much debate. Initial theories suggested that the pulsation occurred because of the rise in intraocular pressure in the eye with the pulse pressure. This article presents an argument that this is not the case. The pulsations are in fact caused by variation in the pressure gradient along the retinal vein as it traverses the lamina cribrosa. The pressure gradient varies because of the difference in the pulse pressure between the intraocular space and the cerebrospinal fluid. The importance of this is that as the intracranial pressure rises the intracranial pulse pressure rises to equal the intraocular pulse pressure and the spontaneous venous pulsations cease. Thus it is shown that cessation of the spontaneous venous pulsation is a sensitive marker of raised intracranial pressure. The article discusses the specificity of the absence of spontaneous venous pulsation and describes how the patient should be examined to best elicit this important sign.
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Selected References
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- Attariwala R., Giebs C. P., Glucksberg M. R. The influence of elevated intraocular pressure on vascular pressures in the cat retina. Invest Ophthalmol Vis Sci. 1994 Mar;35(3):1019–1025. [PubMed] [Google Scholar]
- Dardenne G., Dereymaeker A., Lacheron J. M. Cerebrospinal fluid pressure and pulsatility. An experimental study of circulatory and respiratory influences in normal and hydrocephalic dogs. Eur Neurol. 1969;2(4):193–216. doi: 10.1159/000113796. [DOI] [PubMed] [Google Scholar]
- Dreher A. W., Tso P. C., Weinreb R. N. Reproducibility of topographic measurements of the normal and glaucomatous optic nerve head with the laser tomographic scanner. Am J Ophthalmol. 1991 Feb 15;111(2):221–229. doi: 10.1016/s0002-9394(14)72263-9. [DOI] [PubMed] [Google Scholar]
- Duke-Elder W. S. The venous pressure of the eye and its relation to the intra-ocular pressure. J Physiol. 1926 Jun 22;61(3):409–418. doi: 10.1113/jphysiol.1926.sp002303. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Elliot R. H. THE RETINAL PULSE. Br J Ophthalmol. 1921 Nov;5(11):481–500. doi: 10.1136/bjo.5.11.481. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gücer G., Viernstein L. Long-term intracranial pressure recording in the management of pseudotumor cerebri. J Neurosurg. 1978 Aug;49(2):256–263. doi: 10.3171/jns.1978.49.2.0256. [DOI] [PubMed] [Google Scholar]
- Hedges T. R., Jr, Baron E. M., Hedges T. R., 3rd, Sinclair S. H. The retinal venous pulse. Its relation to optic disc characteristics and choroidal pulse. Ophthalmology. 1994 Mar;101(3):542–547. [PubMed] [Google Scholar]
- Levin B. E. The clinical significance of spontaneous pulsations of the retinal vein. Arch Neurol. 1978 Jan;35(1):37–40. doi: 10.1001/archneur.1978.00500250041009. [DOI] [PubMed] [Google Scholar]
- Levine D. N. Spontaneous pulsation of the retinal veins. Microvasc Res. 1998 Nov;56(3):154–165. doi: 10.1006/mvre.1998.2098. [DOI] [PubMed] [Google Scholar]
- Lorentzen S. E. Incidence of spontaneous venous pulsation in the retina. Acta Ophthalmol (Copenh) 1970;48(4):765–770. [PubMed] [Google Scholar]