Acute macular neuroretinopathy after shock.

Acute macular neuroretinopathy is a rare disease that has been described mainly in women taking hormonal contraceptives. An association either with a viral illness or with the parenteral use of sympathomimetics was sometimes found. We describe its occurrence in a 22-year-old female following an anaphylactic shock after a bee sting, and in a 26-year-old female following a pregnancy complicated with vena cava syndrome and delivery by caesarean section. A combination of factors including hypoperfusion, Valsalva stress, estrogen-induced hematological and rheological changes, and alpha-adrenergic stimulation apparently provoked this clinical manifestation.