Altitude retinopathy is a hemorrhage of the retina and corresponds to a reaction to the falling oxygen partial pressure of the breathing air. The disease is considered a mountaineering disease and can be the sign of altitude sickness. Immediate descent to lower altitudes is required for therapy.
What is altitude retinopathy?
In patients with altitude retinopathy, there are changes in the retina. These changes manifest themselves in the form of hemorrhages, which are often only in the peripheral visual field.
According to abbreviationfinder, retinopathy is a retinal disease that is associated with vascular changes in the retina and can result in permanent retinal damage and visual field impairment. Retinopathy can be caused by anything from swelling to diabetes. The so-called high- altitude retinopathy is a sub-form of the retinopathy group of diseases, which is causally related to natural changes in the breathing air at high altitudes.
This form of retinopathy was first described in 1969. Singh and colleagues are considered the first to describe it. Since the first reports, numerous cases of high-altitude retinopathy have been documented, mostly affecting mountaineers and other alpine athletes. The presence of a pronounced retinopathy can be the symptom of altitude sickness, which can result in life-threatening cerebral edema.
Causes
At high altitudes above sea level, the partial pressure of oxygen in the air we breathe decreases. The vessels of the retina react to the falling oxygen partial pressure. The blood-retinal barrier breaks down: altitude retinopathy sets in. Causal factors are primarily the speed of ascent, one’s own constitution, the severity of the physical exertion and the height reached at the end.
Altitude retinopathy is common from altitudes of 5000 meters above sea level. From 7000 meters they affect almost everyone. Gender doesn’t matter. Since the bleeding mostly occurs in the areas of the peripheral field of vision, the mountaineers often do not notice it subjectively.
Nevertheless, high altitude retinopathy can correlate with vascular changes in the brain and thus be a sign of altitude sickness. However, the connection between the pulmonary and cerebral edema of altitude sickness and severe altitude retinopathy has not yet been conclusively established.
Symptoms, Ailments & Signs
In patients with altitude retinopathy, there are changes in the retina. These changes manifest themselves in the form of hemorrhages, which are often only in the peripheral visual field. As soon as the bleeding is in the central field of vision, the patient perceives the changes subjectively as visual impairment. The vascular changes can be accompanied by edema in the area of the papilla or the optic nerve.
The visual impairment increases particularly when the optic nerve is involved, since the visual information can no longer pass undisturbed into the brain. When the macular area is involved in altitude retinopathy, patients notice the changes immediately and with great intensity. A drop in visual acuity to almost zero is a conceivable symptom of this phenomenon.
If the retinopathy is associated with altitude sickness, it is accompanied by changes in the cerebral vessels and may be associated with severe headaches, vomiting, dizziness, loss of appetite, shortness of breath and tinnitus or general weakness. As a sign of altitude sickness, altitude retinopathy can lead to cerebral or pulmonary edema over time, which can be fatal if left untreated.
Diagnosis & course of disease
The suspected diagnosis of altitude retinopathy is usually not made by the doctor immediately after it occurs, but by those accompanying the person concerned. Significant for this are visible changes in the retina, which the patient describes as reducing vision. Only after the descent is the presence of retinopathy confirmed by doctors or emergency physicians.
In most cases, the diagnosis is backed up by ophthalmological examinations and finally leads to an examination for altitude sickness. The prognosis for patients with altitude retinopathy depends largely on whether the phenomenon is a sign of altitude sickness. Altitude diseases have a much worse prognosis than isolated retinopathies. The time of diagnosis also affects the prognosis.
Complications
In most cases, there are no special or serious complications with altitude retinopathy. The patient can counteract the disease relatively easily and thus easily limit the symptoms. Usually there is a hemorrhage on the retina of the eye. This bleeding causes visual problems in the patient.
These can also lead to blurred vision or double vision and also worsen the general condition of the person concerned. It is not uncommon for headaches, nausea and vomiting to occur. The falling blood pressure can also cause dizziness, which in the worst case can lead to a loss of consciousness. The victim can be injured if they fall. In some cases, there is also shortness of breath and thus panic attacks or sweating.
In general, the patient’s resilience decreases. Altitude retinopathy is treated by descending to a lower altitude. Usually there are no special complications. In acute cases, medication can also be used. Furthermore, the patient must rest and rest. Whether further ascent is possible cannot generally be predicted.
When should you go to the doctor?
If changes in the retina are noticed, a doctor should be consulted immediately. Altitude retinopathy requires rapid evaluation and treatment because serious complications can develop as the disease progresses. Therefore, a doctor should be consulted as soon as the first abnormalities appear. People who suddenly notice a decrease in vision should consult an ophthalmologist. A visit to the doctor is indicated at the latest when accompanying symptoms such as headaches, shortness of breath and nausea and vomiting occur. A general feeling of weakness also requires medical clarification.
If the retinopathy occurs in connection with altitude sickness, a hospital must be visited immediately. If left untreated, the disease can cause life-threatening cerebral or pulmonary edema. Externally, high-altitude retinopathy can be recognized primarily by the visible hemorrhages in the retina. The eye may also be swollen or watery. People who are at an altitude of over 5000 meters above sea level are particularly prone to developing high-altitude retinopathy. Mountain climbers, hikers and Co. should make the descent immediately with the warning signs mentioned and consult a doctor.
Treatment & Therapy
The patient takes the first steps in treating altitude retinopathy himself. A further ascent to even greater heights is absolutely contraindicated. The victim should try to descend as soon as possible. If he is not able to do this because he is also suffering from the symptoms of altitude sickness, it is advisable to contact the mountain rescue service or have the patient transported down by his companions.
In the case of mild to moderate symptoms of altitude sickness, it is recommended to take a break for at least one day. Headaches can be treated with a nonsteroidal anti-inflammatory drug such as ibuprofen. Antiemetics can be given to relieve nausea. Acetazolamide helps with acclimatization. These measures are primarily intended to stabilize the patient and enable him to descend.
In case of severe symptoms, the descent should be made immediately. When possible, patients are given oxygen and dexamethasone to prevent the development of cerebral edema. Whether or not the altitude retinopathy was a sign of altitude sickness, the patient should be examined by a doctor once they reach the bottom. Normally, an isolated retinopathy regresses as soon as the affected person has left the causative altitude.
Prevention
Altitude retinopathy can possibly be prevented by the same prophylaxis as altitude sickness. A slow ascent is desirable. The body adapts only to a certain extent to the changes in altitude in a few days. This adaptation corresponds to the production of red blood cells and is considered acclimatization.
For mountain tours over 4500 meters, the mountaineer should spend at least a week at altitudes of 2000 meters and undertake day tours in higher areas. When ascending, a break every 500 meters of altitude can prevent altitude sickness.
Aftercare
Follow-up care for high-altitude retinopathy focuses primarily on precautionary measures. In order to protect themselves from the symptoms of larger differences in altitude, those affected can take an altimeter with them and train their conscious self-observation. In this way, problems with the retina can be detected in good time.
Climbers who suffer from this disease usually know from experience at what altitude it becomes difficult for them. Then it is advisable to return to the previous position or height so that the symptoms subside. Rapid differences in altitude or short-term mountain tours are not recommended. Intensive preparation and a gradual ascent are better so that the body gets used to the current altitude.
If the symptoms occur more frequently, those affected should consult a doctor. The first sign is vision loss, and then other problems such as headaches and dizziness can occur. However, if the companions have all the necessary information about altitude sickness, it is still possible to take part in mountain tours; provided that those concerned allow themselves enough time.
After the symptoms and the descent, the patients should first rest. This reduces the risk of loss of consciousness, which can lead to accidents and injuries. In such a recovery break, the feeling of panic also disappears.
You can do that yourself
In the case of altitude retinopathy, it is advisable to always carry an altitude measuring device with you. Modern cars have height measurement integrated into their on-board function. In addition, the use of an additional mobile device to attach to clothing is advisable.
Those affected can often estimate the altitude at which their health problems occur based on existing experience. These should only be approached slowly and with several breaks. At the first sign of high altitude retinopathy, it is advisable to change your current position and return to a lower location.
If the symptoms increase, a doctor’s visit is necessary in order not to take any further risks. Avoid sudden changes in altitude. A short-term mountain hike should be avoided as a matter of principle. If there is good preparation and planning for an ascent, many of those affected can also visit places at higher altitudes despite the illness. Several days or weeks should be planned for this, so that the organism can slowly get used to the existing altitude. During this time, a gradual change in altitude is possible and tolerated by the body. To avoid health hazards, the planning should be discussed with a doctor in advance. Accompanying persons must be informed about the illness and good self-reflection is necessary during the change in altitude.
