Purpose To evaluate ocular phototoxicity in mountaineer guide in Chamonix, France, exposed to altitude characterized by increased ultraviolet (UV) radiation. Methods 96 guides working and 90 subjects living in plains, older than 50 years, replied to a questionnaire assessing altitude exposure and wearing protective eyewear. We performed slit lamp examination after pupil dilatation, retinal photography (Topcon) and crystalline lens density analysis (Oculyzer®, Alcon). Student t‐test was used to compare the groups and logistic regression to evaluate risks factors in guides group. Results Guides mean age was 59.8years and 59.1 for control (p=0.39). Guides developed more chronic blepharitis (52.1% vs. 10.6%, p<0.01), pterygium (8.9% vs. 0%, p<0.01), pinguecula (58.3% vs. 21.7%, p<0.001). Their corneal break up time was shorter (4.5secs vs. 7secs, p<0.01). Guides presented more cortical cataract (p<0.01) and cataract surgery (p=0.01). Only 61.5% guides had normal ocular fundus vs. 81.1% in control group (p<0.01). They developed more drusenoid deposit (27.2% vs. 15.6%, p<0.01). Guides group analysis showed that exposure superior to 3000m is risk factor to develop anterior cortical cataract (OR=1.16, p<0.01). Exposition to snow increases risk of maculopathy (OR=1.9, p<0.01). Questionnaire reveals discontinuous eye protection in medium altitude. Wearing ski mask reduces cataract, age related maculopathy and chronic blepharitis risk. Conclusion Ocular findings highlight the higher incidence of ocular surface pathology, anterior cortical lens opacities and drunenoid deposits. This data emphasize the potential deleterious role of UVs and importance to wear sunglasses even in low to medium altitude but also when climbing.

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Purpose To report the clinical characteristics of 3 cases of high altitude retinopathy (HAR) and a review of the literature. Methods We report 3 cases of patients consulting for HAR after high trekking above 7000m. Results Patient 1 was a 27 years‐old man, high level sportsman, coming back from a GASNERBRUM expedition (7600m) and complaining of right eye central scotoma. Fundus examination revealed 2 haemorrhages : one next the fovea and one on the temporal arcade vessel. Patient 2 was a 52 years‐old man, high mountain guide, coming back from EVERSEST ascent (8000m) and complaining of left eye central scotoma and visual acuity deficit. Fundus examination found one parafoveal haemorrhage in the left eye and paramacular haemorrhages in the right eye. Patient 3 was a young 25 years‐old military doctor coming back from a high altitude expedition (7000m), he was complaining of right eye central scotoma during the descent and headache. Fundus examination found three macular haemorrhages and one on the inferior temporal arcade vessel. Only one of the three patients presented other symptomes of high altitude illness. All of us presented a positive outcome with complete functional and anatomical resolution of HAR, less than 2 month, without sequela. Conclusion The real incidence and physiopathology of HAR are not very well known. Retinal haemorrhages after a high trekking are an early manifestation of HAR and more generally high altitude illness. It usually occurs at altitudes above 4000m. While macular involvement or retinal vein occlusion may result in permanent visual acuity deficit, these haemorrhages are generally asymptomatic and spontaneous regressive.