APPENDIX C: SPONTANEOUS VENOUS PULSATIONS

- Spontaneous venous pulsations (SVPs) are subtle, rhythmic variations in retinal vein caliber on the optic disc and have an association with ICP.
- It is difficult to see SVPs without advanced equipment; however, if a handheld ophthalmoscope is available, it is worth an attempt to visualize the retinal veins.
- Don’t worry if you cannot see SVPs; this may actually be normal. However, if you do see them, it is very reassuring that ICP is normal.10
- If SVPs are initially present and can no longer be seen on subsequent examinations, the provider should be concerned for increasing ICP.

Technique

1. Gently lift the eyelid until the pupil is in view.
2. Using a handheld ophthalmoscope, the provider should maneuver himself or herself to a position where the optic disc can be visualized.
3. Identify the retinal veins as they emerge from the optic disc. Retinal veins are typically slightly larger and darker than retinal arteries. Figure 1 demonstrates the typical appearance of the retina.
4. Observe the retinal veins for pulsations. Note the presence or absence of spontaneous venous pulsations
5. Repeat the step 1–4 sequence in the contralateral eye.