Asymptomatic retinal haemorrhage is common at altitudeBMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7008.812c (Published 23 September 1995) Cite this as: BMJ 1995;311:812
- Robert E MacLaren
EDITOR,--In their article on mountaineering medicine Christine H D A'Court and colleagues neglect to discuss one of the commonest medical disorders at altitude; retinal haemorrhage.1 This is surprising since macular haemorrhage is listed as having affected one member of their team and was probably detected only after the subject complained of central visual field loss.
Retinal haemorrhage at altitude is usually symptomless and has been studied in detail only relatively recently. Funduscopy performed on expeditions over 6000 m has shown an incidence of 36% in 39 subjects climbing Mount McKinley,2 29% in 14 army recruits climbing in Nepal,3 and 29% in 14 subjects and 20% in 30 subjects climbing Mount Everest.4 5 Retinal haemorrhage at altitude also occurs as a result of severe cerebral oedema,5 but little is known of the aetiology of the condition when it develops spontaneously. Links have been made to heavy exercise at altitude2 3 and use of non-steroidal anti-inflammatory drugs.4
Regular funduscopy should therefore be undertaken by expedition doctors to detect the presence of haemorrhages in otherwise symptomless people. Direct ophthalmoscopy in a darkened tent should be sufficient. While the presence of a small (diameter less than one half disc) uncomplicated haemorrhage may not necessarily be an indication for descent, certain factors may lead to long term damage to the eye--for instance, rebleeding, involvement of the vitreous, the presence of a detectable scotoma, or symptoms of early retinal detachment--and descent should be advocated when these are present. The desire to climb has to be balanced against the possibility of long term visual impairment.
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