gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Ocular fundus findings in patients with cerebral malaria tropica

Meeting Abstract

  • corresponding author C. Hirneiß - University eye hospital Munich
  • M. Tast - University eye hospital Munich
  • V. Klauß - University eye hospital Munich
  • A. Kampik - University eye hospital Munich
  • T. Taylor - Blantyre Malaria Project, Blantyre, Malawi
  • S. Lewallen - Kilimanjaro Centre for Community Ophthalmology, Tumaini University/KCMC, Moshi, Tanzania

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogFR.15.03

The electronic version of this article is the complete one and can be found online at:

Published: September 22, 2004

© 2004 Hirneiß et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




Malaria is a tropical disease causing 300 million infections per year and one million deaths. The most common form is malaria tropica caused by Plasmodium falciparum. Due to its high mortality, cerebral malaria (CM) is the most important organ manifestation of malaria tropica. Descriptions of the ocular fundus in malaria infection originate as early as from 1922. The full spectrum of ocular changes has been described for the first time in the early 90ies using indirect ophthalmoscopy and dilated pupils.


Children suffering cerebral malaria who were admitted to the Blantyre Malaria Project (Malawi, Africa) were examined. Pupils were fully dilated and an indirect ophthalmoscopy was done. The optic nerve head, central and peripheral retina and central and peripheral vessels were described and photographs were taken.


The spectrum and severity of findings of the ocular fundus in children with CM are wide and include the following five distinct entities: haemorrhages, cotton wool spots, papilloedema, retinal whitening and retinal vessel abnormalities. Most of the retinal haemorrhages have white centres and remind of Roth spots. Only 5% of patients show cotton wool spots. Papilloedema is also not very common (8%) but indicates a bad prognosis for survival. Retinal whitening is more common at the posterior pole than in the periphery. 20% of patients show retinal vessel abnormalities that are unique to severe malaria. The colour of the vessels may be orange or white; this phenomenon is due to dehaemoglobinized erythrozytes caused by the parasites.


The partially pathognomonic ocular changes in CM vary with the severity of the disease. They are important parameters in differential diagnosis to other causes of infectious coma like meningitis. Also, they are a of great value for prognosis.