Ocular Problems in High-Altitude Traveling: A Review With Focus on Management

Document Type : Review Article

Authors

1 Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran

3 Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Traveling to high altitudes can expose the eye to reduced ambient cold and low-pressure environments. These conditions can affect the physiology of the eye and may result in ocular problems and visual disturbances. In this paper, ocular disorders related to high altitudes are briefly reviewed. Then, high-altitude ocular disorders are categorized in three parts: those related to dry and cold environments, those related to low-pressure environments, and those in people with past ocular conditions. In every part, the signs and symptoms of related diseases are discussed. Up-to-date recommendations for the management and prevention of these disorders are presented. The main management for ocular disorders related to dry and cold environments includes the use of eye shields and artificial tear drops. Descending to low-altitude lands is the key to managing eye problems associated with low-pressure environments. Patients with past ocular problems or ocular surgery should consult their doctors before ascending to high altitudes.

Keywords

References

  1. Ellerton JA, Zuljan I, Agazzi G, Boyd JJ. Eye problems in mountain and remote areas: prevention and onsite treatment—official recommendations of the International Commission for Mountain Emergency Medicine ICAR MEDCOM. Wilderness Environ Med. 2009;20(2):169-175. doi:10.1580/08-WEME-REV-205R1.1.
  2. Mader TH, Tabin G. Going to high altitude with preexisting ocular conditions. High Alt Med Biol. 2003;4(4):419-430. doi:10.1089/152702903322616173.
  3. Karaküçük S, Mirza GE, Rul G. Ophthalmological effects of high altitude. Ophthalmic Res. 2000;32(1):30-40.
  4. Jokela K, Leszczynski K, Visuri R. Effects of Arctic ozone depletion and snow on UV exposure in Finland. Photochem Photobiol. 1993;58(4):559-566.
  5. McKenzie RL, Johnston PV, Smale D, Bodhaine BA, Madronich S. Altitude effects on UV spectral irradiance deduced from measurements at Lauder, New Zealand, and at Mauna Loa Observatory, Hawaii. J Geophys Res. 2001;106(D19):22845-22860.
  6. Meinander O, Kontu A, Asmi E, Sanchez R, Mei M, de Leeuw G. Bipolar high temporal resolution measurements of snow UV albedo in Sodankylä and Marambio. Paper presented at: EGU General Assembly Conference Abstracts; 2015.
  7. Schein OD. Phototoxicity and the cornea. J Natl Med Assoc. 1992;84(7):579.
  8. Willmann G. Ultraviolet Keratitis: from the pathophysiological basis to prevention and clinical management. High Alt Med Biol. 2015;16(4):277-282. doi:10.1089/ham.2015.0109.
  9. Blumthaler M, Ambach W, Daxecker F. On the threshold radiant exposure for keratitis solaris. Invest Ophthalmol Vis Sci. 1987;28(10):1713-1716.
  10. Patel M, Fraunfelder FW. Toxicity of topical ophthalmic anesthetics. Expert Opin Drug Metab Toxicol. 2013;9(8):983-988. doi:10.1517/17425255.2013.794219.
  11. Morris DS, Evans S. Visual performance in extreme sports. In: Feletti F, ed. Extreme Sports Medicine. Springer; 2017:417-428.
  12. Bartlett JD, Keith MS, Sudharshan L, Snedecor SJ. Associations between signs and symptoms of dry eye disease: a systematic review. Clin Ophthalmol. 2015;9:1719-1730. doi:10.2147/OPTH. S89700.
  13. Gupta N, Prasad I, Himashree G, D’Souza P. Prevalence of dry eye at high altitude: a case controlled comparative study. High Alt Med Biol. 2008;9(4):327-334. doi:10.1089/ham.2007.1055.
  14. Kangari H, Eftekhari MH, Sardari S, et al. Short-term consumption of oral omega-3 and dry eye syndrome. Ophthalmology. 2013;120(11):2191-2196. doi:10.1016/j.ophtha.2013.04.006.
  15. Diez-Feijóo E, Grau AE, Abusleme EI, Durán JA. Clinical presentation and causes of recurrent corneal erosion syndrome: review of 100 patients. Cornea. 2014;33(6):571-575. doi:10.1097/ICO.0000000000000111.
  16. Basnyat B, Wu T, Gertsch JH. Neurological conditions at altitude that fall outside the usual definition of altitude sickness. High Alt Med Biol. 2004;5(2):171-179.
  17. Dickinson J. Transient monocular amaurosis at high altitude. High Alt Med Biol. 2001;2(1):75-75.
  18. Basnyat B, Cumbo TA, Edelman R. Acute medical problems in the Himalayas outside the setting of altitude sickness. High Alt Med Biol. 2000;1(3):167-174.
  19. Virués-Ortega J, Buela-Casal G, Garrido E, Alcázar B. Neuropsychological functioning associated with high-altitude exposure. Neuropsychol Rev. 2004;14(4):197-224.
  20. Dickinson JG. High altitude cerebral edema: Cerebral acute mountain sickness. Paper presented at: Seminars in Respiratory Medicine; 1983.
  21. Kramár PO, Drinkwater BL, Folinsbee LJ, Bedi JF. Ocular functions and incidence of acute mountain sickness in women at altitude. Aviat Space Environ Med. 1983;54(2):116-120.
  22. Murdoch DR. Lateral rectus palsy at high altitude. J Wilderness Med. 1994;5(2):179-181.
  23. Singh I, Khanna P, Srivastava M, Lal M, Roy SB, Subramanyam C. Acute mountain sickness. N Engl J Med. 1969;280(4):175-184.
  24. Frayser R, Houston CS, Bryan AC, Rennie ID, Gray G. Retinal hemorrhage at high altitude. N Engl J Med. 1970;282(21):1183-1184.
  25. Rennie D, Morrissey J. Retinal changes in Himalayan climbers. Arch Ophthalmol. 1975;93(6):395-400.
  26. Shults WT, Swan KC. High altitude retinopathy in mountain climbers. Arch Ophthalmol. 1975;93(6):404-408.
  27. Wiedman M. High altitude retinal hemorrhage. Arch Ophthalmol. 1975;93(6):401-403.
  28. McFadden DM, Houston CS, Sutton JR, Powles AP, Gray GW, Roberts RS. High-altitude retinopathy. JAMA. 1981;245(6):581-586.
  29. Hanifudin A, Lim LT, Ah-Kee EY, El-Khashab T. High altitude subhyaloid hemorrhage. Oman J Ophthalmol. 2015;8(3):213.
  30. Morris DS, Severn PS, Smith J, Somner JE, Stannard KP, Cottrell DG. High altitude and retinal detachment. High Alt Med Biol. 2007;8(4):337-339.
  31. Bandyopadhyay S, Singh R, Gupta V, Gupta A. Anterior ischaemic optic neuropathy at high atitude. Indian J Ophthalmol. 2002;50(4):324.
  32. Butler FK, Harris DJ, Reynolds RD. Altitude retinopathy on Mount Everest, 1989. Ophthalmology. 1992;99(5):739-746.
  33. Arora R, Jha K, Sathian B. Retinal changes in various altitude illnesses. Singapore M J. 2011;52(9):685-688.
  34. Morris DS, Mella S, Depla D. Eye problems on expeditions. Travel medicine and infectious disease. 2013;11(3):152-158.
  35. Wiedman M, Tabin GC. High-altitude retinopathy and altitude illness. Ophthalmology. 1999;106(10):1924-1927.
  36. Clarke C, Duff J. Mountain sickness, retinal haemorrhages, and acclimatisation on Mount Everest in 1975. Br Med J. 1976;2(6034):495-497.
  37. Bosch MM, Barthelmes D, Merz TM, et al. High incidence of optic disc swelling at very high altitudes. Arch Ophthalmol. 2008;126(5):644-650. doi:10.1001/archopht.126.5.644.
  38. Willmann G, Fischer MD, Schatz A, et al. Quantification of optic disc edema during exposure to high altitude shows no correlation to acute mountain sickness. PLoS One. 2011;6(11):e27022. doi:10.1371/journal.pone.0027022.
  39. Morris DS, Somner J, Donald MJ, et al. The eye at altitude. Hypoxia and Exercise. Springer; 2006:249-270.
  40. Pavlidis M, Stupp T, Georgalas I, Georgiadou E, Moschos M, Thanos S. Intraocular pressure changes during highaltitude acclimatization. Graefes Arch Clin Exp Ophthalmol. 2006;244(3):298-304.
  41. Cymerman A, Rock PB, Muza SR, et al. Intraocular pressure and acclimatization to 4300 M altitude. Aviat Space Environ Med. 2000;71(10):1045-1050.
  42. Somner JE, Morris DS, Scott KM, MacCormick IJ, Aspinall P, Dhillon B. What happens to intraocular pressure at high altitude? Invest Ophthalmol Vis Sci. 2007;48(4):1622-1626. doi:10.1167/iovs.06-1238.
  43. Mieske K, Flaherty G, O’Brien T. Journeys to high altitude—risks and recommendations for travelers with preexisting medical conditions. J Travel Med. 2010 n;17(3):214. doi:10.1111/j.1708-8305.2010.00414.x.
  44. Winkle RK, Mader TH, Parmley VC, White LJ, Polse KA. The etiology of refractive changes at high altitude after radial keratotomy: hypoxia versus hypobaria. Ophthalmology. 1998;105(2):282-286.
  45. Mader TH, Blanton CL, Gilbert BN, et al. Refractive changes during 72-hour exposure to high altitude after refractive surgery. Ophthalmology. 1996;103(8):1188-1195.
  46. Mader TH, White LJ, Johnson DS, Barth FC. The ascent of Mount Everest following radial keratotomy. Wilderness & Environmental Medicine. 2002;13(1):53-4.
  47. Wilson DF, Roy A, Lahiri S. Immediate and long-term responses of the carotid body to high altitude. High Alt Med Biol. 2005;6(2):97-111.
  48. Houston S, Graf J, Sharkey J. Commercial air travel after intraocular gas injection. Aviat Space Environ Med. 2012;83(8):809-810.
  49. Levasseur SD, Rahhal FM. Travel to high mountain elevations following vitrectomy with intraocular gas. Retina. 2013;33(7):1456-1461. doi:10.1097/IAE.0b013e318280766f.
  50. Kokame GT, Ing MR. Intraocular gas and low-altitude air flight. Retina. 1994;14(4):356-358.
  51. Lincoff H, Weinberger D, Reppucci V, Lincoff A. Air travel with intraocular gas: I. The mechanisms for compensation. Arch Ophthalmol. 1989;107(6):902-906.
  52. Mills MD, Devenyi RG, Lam W-C, Berger AR, Beijer CD, Lam SR. An assessment of intraocular pressure rise in patients with gas-filled eyes during simulated air flight. Ophthalmology. 2001;108(1):40-44.
  53. Lincoff H, Weinberger D, Stergiu P. Air travel with intraocular gas: II. Clinical considerations. Arch Ophthalmol. 1989;107(6):907-910.
  54. Moore K, Vizzard N, Coleman C, McMahon J, Hayes R, Thompson C. Extreme altitude mountaineering and type 1 diabetes; the Diabetes Federation of Ireland Kilimanjaro Expedition. Diabet Med. 2001;18(9):749-755.
  55. Leal C, Admetlla J, Viscor G, Ricart A. Diabetic retinopathy at high altitude. High Alt Med Biol. 2008;9(1):24-27.

Files

History

  • Receive Date: 29 December 2016
  • Revise Date: 03 February 2017
  • Accept Date: 22 February 2017
  • First Publish Date: 01 June 2017

Share

How to cite

Statistics