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Journal of Neurology Neurosurgery and Psychiatry 2003;74:7-9
© 2003 Journal of Neurology Neurosurgery and Psychiatry

PHYSICAL SIGNS

Spontaneous retinal venous pulsation: aetiology and significance

A S Jacks1, N R Miller2

1 Centre for Defence Medicine, Birmingham, UK
2 Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA

Correspondence to:
Mr A S Jacks, Selly Oak Hospital, Block K, Raddlebarn Road, Birmingham B29 6JD, UK;
andrewjacks{at}doctors.org.uk

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.

Keywords: spontaneous venous pulsation; retinal vein; swollen optic disc; papilloedema; idiopathic intracranial hypertension

Abbreviations: CRV, central retinal vein; CSF, cerebrospinal fluid; IOP, intraocular pressure; RVP, retinal venous pressure; SVP, spontaneous retinal venous pulsation




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