Ophthalmoscopic abnormalities in adults with falciparum malaria

We studied 424 adults with falciparum malaria admitted over 28 months. They were divided into three groups: cerebral malaria (n = 214); severe non-cer ebral malaria (n = 58); and uncomplicated malaria (n = 152). Fundus examina tion was done daily from admission to discharge, and weekly thereafter in t hose with persistent changes. All patients were treated by a protocol based on WHO guidelines. Ophthalmoscopic abnormalities were: retinal haemorrhage s, 40 (9.43%) (25 cerebral malaria, 10 severe non-cerebral and five uncompl icated malaria); papilloedema, 17 (7.94%) cerebral malaria and two uncompli cated malaria; blurring of disc margins, 25 (11.68%) cerebral and seven non -cerebral; retinal oedema, six (2.80%) cerebral and five non-cerebral malar ia; disc pallor, five patients all with cerebral malaria; vitreous haemorrh age and hard exudate in one patient each, both cerebral malaria. Retinal ha emorrhage was associated with cerebral malaria and severe non-cerebral mala ria, especially with severe anaemia (p < 0.001), as compared to uncomplicat ed malaria (p < 0.01). The association of papilloedema and cerebral malaria was highly significant compared to severe non-cerebral malaria (p < 0.001) . None of these findings was associated with statistically significant mort ality, except disc pallor in cerebral malaria (p < 0.05).