[High altitude retinopathy: report of 3 cases]

Abstract

Purpose: To report three cases of vision loss occurring at high altitude.

Observations: Three patients aged 27 to 52 years presented with scotoma and/or visual acuity deficit upon their return from high altitude expeditions above 6000 m. Fundus examination revealed multiple posterior pole hemorrhages, resolving completely by two months.

Discussion: Exposure to hypobaric hypoxia at high altitude leads to adaptation mechanisms in order to maintain retinal oxygenation. Certain individuals have an inadequate autoregulatory response and develop signs of "high altitude retinopathy" (HAR), including retinal hemorrhages most often, with occasional vitreous hemorrhage, optic nerve head edema and retinal vein occlusion. The pathophysiology of HAR is not well understood. Identified risk factors include altitude above 4000 m, rapid ascent and personal susceptibility. Age and fitness are unrelated. Association with acute mountain sickness, high-altitude pulmonary edema and high-altitude cerebral edema is still controversial.

Conclusion: Retinal hemorrhages occurring after high-altitude hiking are an early manifestation of HAR and are part of high-altitude illness. HAR usually occurs at altitudes above 4000 m, is generally asymptomatic, and spontaneously regresses. A maladaptive autoregulatory response to hypobaric hypoxia appears to be the cause of HAR.

Keywords: Haute altitude; High altitude; Hypobaric hypoxia; Hypoxie hypobare; Hémorragie rétinienne; Retinal hemorrhages; Rétinopathie.