High altitude retinopathy

Background

• Retinal hemorrhages are common at sleeping altitudes > 5000m (16,000ft)
• Incidence increases with higher altitude

Clinical Features

Roth spots due to retinal vein occlusion

• Roth Spots: retinal hemorrhages with white center, seen on fundoscopy
• Cotton wool spots on fundoscopy
• May be asymptomatic, or cause visual loss

Differential Diagnosis

Acute Vision Loss (Noninflamed)

• Painful
  • Arteritic anterior ischemic optic neuropathy
  • Optic neuritis
  • Temporal arteritis^†
• Painless
  • Amaurosis fugax
  • Central retinal artery occlusion (CRAO)^†
  • Central retinal vein occlusion (CRVO)^†
  • High altitude retinopathy
  • Open-angle glaucoma
  • Posterior reversible encephalopathy syndrome (PRES)
  • Retinal detachment^†
  • Stroke^†
  • Vitreous hemorrhage
  • Traumatic optic neuropathy (although may have pain from the trauma)

^†Emergent Diagnosis

High Altitude Illnesses

• Acute mountain sickness
• Chronic mountain sickness
• High altitude cerebral edema
• High altitude pulmonary edema
• High altitude peripheral edema
• High altitude retinopathy
• High altitude pharyngitis and bronchitis
• Ultraviolet keratitis

Evaluation

• Clinical diagnosis

Management

• Not considered an indication for descent unless vision changes are present

Disposition

• Generally improves with descent. If persistent visual loss, referral to ophthalmology

See Also

• High altitude medicine