Purpose: To present a complication of repeated Valsalva maneuver.
Methods: Case report with serial intravenous fluorescein angiography and comprehensive workup for coagulopathies.
Results: After playing strenuous musical pieces, a solo trombonist suffered within 1 year three attacks of visual loss in the right eye; he had two attacks of inferior hemi-central retinal vein occlusion 2 months apart, followed by central retinal vein occlusion 10 months later. Final best spectacle-corrected visual acuity was 6/60. He ended his professional career, and no further attacks occurred in the following 10 years.
Conclusion: Retinal vein occlusion with irreversible visual loss can occur after playing a strenuous piece of music on a high-resistance instrument.