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PHOTO ESSAY
Year : 2018  |  Volume : 30  |  Issue : 2  |  Page : 136-137

Macular hemorrhage in high altitudes traveler


1 Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh; Department of Community Ophthalmology, Global Hospital Institute of Ophthalmology, Talehati, Rajasthan, India
2 Department of Community Ophthalmology, Global Hospital Institute of Ophthalmology, Talehati, Rajasthan, India

Date of Web Publication28-Aug-2018

Correspondence Address:
Amit Mohan
Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_42_18

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How to cite this article:
Mohan A, Kaur N. Macular hemorrhage in high altitudes traveler. Kerala J Ophthalmol 2018;30:136-7

How to cite this URL:
Mohan A, Kaur N. Macular hemorrhage in high altitudes traveler. Kerala J Ophthalmol [serial online] 2018 [cited 2018 Dec 11];30:136-7. Available from: http://www.kjophthal.com/text.asp?2018/30/2/136/239976

A 29-year-old male presented with sudden painless diminution of vision for 4 days in the left eye. Vision was 6/6 in the right eye and 6/36 in the left eye. The anterior segment was within normal limits. Posterior segment biomicroscopy with 90D revealed premacular hemorrhage in the left eye confirmed on fundus photography [Figure 1]. Optical coherence tomography showed a highly reflective, sharply demarcated, and dome-shaped hemorrhage in the superficial retinal layer [Figure 2]. There was no history of trauma, heavy exertion, and valsalva maneuvering. Complete hemogram, coagulation profile, and peripheral blood smear are within normal limits. On inquiring about any visit to hill station, the patient gave the positive history of travel to Leh 10 days back by air leading to rapid ascent. At 6-week follow-up, there was complete resolution of premacular hemorrhage with the attainment of 6/6 vision.
Figure 1: Premacular hemorrhage

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Figure 2: Optical coherence tomography showing a highly reflective, sharply demarcated, and dome-shaped hemorrhage in the superficial retinal layer at the macula

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High-altitude illness is a rare cause of premacular hemorrhage.[1] It occurs due to rapid ascent to high altitude >2500 m.[2] Leh is at an altitude of 3524 m. It may be associated with retinal vascular dilatation, superficial hemorrhages, papilledema, vitreous hemorrhage, exudates, neovascularization, glial bands, and retinal detachment.[3] High-altitude retinopathy was graded by Weidman according to number and area of distribution of retinal hemorrhage.[4] He has only premacular hemorrhage with no other findings. There are several other causes of premacular hemorrhages which include proliferative diabetic retinopathy, anemic retinopathy, blunt trauma, retinal vein occlusion, Valsalva retinopathy, retinal macroaneurysm rupture, Terson syndrome, Shaken baby syndrome, and age-related macular degeneration.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Hanifudin A, Lim LT, Ah-Kee EY, El-Khashab T. High altitude subhyaloid hemorrhage. Oman J Ophthalmol 2015;8:213-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Paralikar SJ, Paralikar JH. High-altitude medicine. Indian J Occup Environ Med 2010;14:6-12.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Goswami BL. High altitude retinal haemorrhage. Indian J Ophthalmol 1984;32:321-4.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Wiedman M. High altitude retinal hemorrhage. Arch Ophthalmol 1975;93:401-3.  Back to cited text no. 4
    
5.
Mennel S. Subhyaloidal and macular haemorrhage: Localisation and treatment strategies. Br J Ophthalmol 2007;91:850-2.  Back to cited text no. 5
    


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