Differential Diagnosis of Blood in Multiple Retinal Layers: Terson Syndrome Mimicking Valsalva Retinopathy

PURPOSE: To describe a case of multilayer intraocular hemorrhage initially suspected to be Valsalva retinopathy but ultimately diagnosed as Terson syndrome. METHODS: Clinical examination and diagnostic imaging were performed, and a focused literature review of conditions associated with multilayer retinal hemorrhage was conducted. RESULTS: A 33-year-old male presented with vitreous, intraretinal, and subretinal hemorrhage. Although initial history suggested Valsalva retinopathy, further questioning revealed recent head trauma. Head CT demonstrated a parafalcine subdural hematoma consistent with Terson syndrome, and the patient was admitted for neurosurgical management. CONCLUSION: Multilayer retinal hemorrhage warrants thorough history-taking and urgent imaging to distinguish Terson syndrome from mimickers such as Valsalva retinopathy.