Images in Clinical Medicine

Retinal Hemorrhages Associated with High Altitude

Sankaranarayana P. Mahesh, M.D., and Jeevan R. Mathura, Jr., M.D.

N Engl J Med 2010; 362:1521April 22, 2010

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A 50-year-old man presented with blurry vision and scotomas in his right eye immediately after a 2-week hiking trip in the Andes at an altitude of 19,600 ft (6000 m). During the 2 weeks, he was taking acetazolamide in an effort to prevent altitude sickness and reported having no symptoms during his hike. On examination, his visual acuity was 20/50 in the right eye and 20/20 in the left eye. He had no afferent pupillary defect and had normal color vision and brightness perception in both eyes. Ophthalmoscopy revealed foveal hemorrhages in the right eye (Panel A) and peripapillary intraretinal hemorrhage in the left eye (Panel B), with no evidence of papilledema. The pulmonary and nervous system examinations were normal. High-altitude retinopathy is a common finding among hikers at altitudes above 16,000 ft (4900 m) and may portend the onset of more serious manifestations of high-altitude sickness, including cerebral or pulmonary edema. The patient's retinal hemorrhages were managed conservatively. On follow-up, 2 months after the initial visit, the patient's visual acuity had returned to 20/25 in the right eye. Ophthalmoscopy showed almost complete resolution of the retinal hemorrhages.

Sankaranarayana P. Mahesh, M.D.
Jeevan R. Mathura, Jr., M.D.
George Washington University, Washington, DC
maheshs@gwu.edu

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