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BRIEF REPORT
Year : 2002  |  Volume : 50  |  Issue : 4  |  Page : 324-325

Anterior ischaemic optic neuropathy at high atitude


Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh-160 012, India

Correspondence Address:
S Bandyopadhyay
Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh-160 012
India
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Source of Support: None, Conflict of Interest: None


PMID: 12532501

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  Abstract 

High altitude retinopathy with various manifestations is common after exposure to high altitude. Inadequate autoregulatory response of the retinal vascular system is thought to be responsible for this. We report a case of anterior ischaemic optic neuropathy following
exposure to high altitude.

Keywords: Anterior ischaemic optic neuropathy, high altitude, retinopathy


How to cite this article:
Bandyopadhyay S, Singh R, Gupta V, Gupta A. Anterior ischaemic optic neuropathy at high atitude. Indian J Ophthalmol 2002;50:324-5

How to cite this URL:
Bandyopadhyay S, Singh R, Gupta V, Gupta A. Anterior ischaemic optic neuropathy at high atitude. Indian J Ophthalmol [serial online] 2002 [cited 2020 May 29];50:324-5. Available from: http://www.ijo.in/text.asp?2002/50/4/324/14756

High altitude retinopathy is a recognised entity that occurs following exposure to heights of more than 4,500 meters above mean sea level.[1][2][3][4][5][6][7] The various ocular changes reported are retinal haemorrhage,[3],[7] retinal vascular tortuosity,[3] disc oedema,[3] cotton wool spots[5] and central retinal vein occlusion.[6] We report a case of unilateral anterior ischaemic optic neuropathy that occurred at an altitude of 5472 meters above mean sea level.


  Case report Top


A 33-year-old male presented complaining of loss of vision in the lower half of the right eye of three weeks' duration. When he became symptomatic he had been staying at the Siachen glacier (5472 meters above mean sea level) for three months. Ten days after onset of symptoms he came down to the plains and presented to us. He had no associated systemic disease and was a non-smoker.

Ocular examination showed best corrected visual acuity of 6/6 in both eyes. There was relative afferent pupillary defect in the right eye. The anterior segment of both eyes was normal with intraocular pressure (IOP) of 14mm Hg in both eyes. Fundoscopy of the right eye showed pale disc oedema in the superior half of the optic disc [Figure - 1]a, while the left eye was normal. Fundus fluorescein angiography of the right eye showed initial hypofluorescence [Figure - 1]b with late optic disc staining in the superior half [Figure - 1]c, consistent with the diagnosis of anterior ischaemic optic neuropathy. Visual field examination (30-2 threshold list) on Humphrey's perimeter showed inferior altitudinal defect in the right eye with normal visual field in the left eye [Figure - 2]a.

The investigative work up including total blood counts, erythrocyte sedimentation rate, lipid profile and blood sugar were noncontributory and the hematocrit value was normal (44%). At three months' follow-up, he maintained 6/6 vision in the both eyes, but field loss persisted [Figure:2b].


  Discussion Top


High altitude retinopathy is a well known distinct entity.[1][2][3] Ischaemic optic neuropathy, however, has not been described after high altitude exposure. Autoregulation of retinal vessels may play a major role in maintaining normal circulation in eyes that are exposed to chronic hypoxia as may occur at high altitude.[3] Measurement of retinal blood flow in mountaineers of the first Vienna Himalayan expedition showed a marked increase in retinal blood flow (up to 96%) in 5 of 7 eyes, of which two had retinal haemorrhage.[8] The remaining two patients who had a 21-30% decrease in retinal blood flow due to spasm of retinal vessels, did not show any signs of high altitude retinopathy.[8] This study showed that high altitude retinopathy is essentially seen in climbers with ocular vascular dysregulation. Another possible mechanism is an increased hematocrit value with increased blood viscosity that could be responsible for the occurrence of various manifestations of altitude-related retinal diseases.[2] The patient described here had a normal hematocrit value. We speculate that an inadequate autoregulatory response, under conditions of chronic hypoxia, may have led to sustained vasospasm, which could in turn have reduced the blood supply to the optic nerve head, leading to anterior ischaemic optic neuropathy.

 
  References Top

1.
Frayser R, Houston C, Bryan AC, Rennie ID. Retinal hemorrhage at high altitude. N Engl J Med 1970;282:183-84.  Back to cited text no. 1
    
2.
Lang GE, Kuba GB. High altitude retinopathy. Am J Ophthalmol 1997;123:418-20.  Back to cited text no. 2
[PUBMED]    
3.
Braun U, Braun M, Jonas JB. High altitude retinopathy after Himalayan ascent. Klin Monatsbl Augenheilkd 1997;211:213-14.  Back to cited text no. 3
[PUBMED]    
4.
Singh I, Khanna PK, Shrivastava MC, Lal M, Roy SB, Subramanyam SV. Acute mountain sickness. N Engl J Med 1969;280:175-84.  Back to cited text no. 4
    
5.
McFaden DM, Houston CS, Sutton JR, Powles AC, Gray GW, Roberts RS. High altitude retinopathy. JAMA 1981;245:581-86.  Back to cited text no. 5
    
6.
Butler FK, Harris DJ, Reynolds RD. Altitude retinopathy on Mount Everest, 1989. Ophthalmol 1992;99:739-46.  Back to cited text no. 6
    
7.
Botella MJ, Martinez CR. High altitude retinal hemorrhages in the expeditions to 8000 meters peaks. A study of 10 cases. Medclin (Barc) 1998;110:457-61.  Back to cited text no. 7
    
8.
Mullner EA, Rainer G, Strenn K, Zidek T. High altitude retinopathy and retinal vascular dysregulation. Eye 2000;14:724-29.  Back to cited text no. 8
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]


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