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    5 things you need to know: Eyes harbor Ebola virus after cure

    Eyes harbor Ebola virus after cure

    Atlanta—Months after being cleared, the Ebola virus was found in the ocular fluid of a survivor, according to a recent report from The New England Journal of Medicine.

    After weeks of treatment at Emory University Hospital in Atlanta, healthcare professionals found the 43-year-old man—a physician who contracted Ebola while working in Sierra Leone—clear of the virus by urine and blood tests. But shortly after discharge from the hospital, his ophthalmic symptoms included occasional bilateral ocular burning, foreign-body sensation, and photophobia, according to the report. He required an adjustment in his prescription for reading glasses, which suggested an accommodative change. His ocular history was clinically significant only for myopia. 

    Drug Topics: Sierre Leone testing new Ebola vaccine

    Three months after discharge, he was referred to the Emory Eye Center, where an examination of the dilated posterior eye revealed previously undocumented multiple, peripheral chorioretinal scars with hypopigmented halos in both eyes and a small intraretinal hemorrhage adjacent to one scar in the left eye. The patient was diagnosed with posterior uveitis.

    A month later, when he presented with an acute onset of redness, blurred vision with halos, pain, and photophobia in the left eye, the patient was then diagnosed with anterior uveitis and ocular hypertension.

    When the patient did not respond to treatment and the inflammation and other symptoms continued to worsen, a paracentesis of the anterior chamber was performed. The aqueous humor tested positive for the Ebola virus. Researchers did not find the Ebola virus in the tear fluid or conjunctiva.

    “Although the pathogenesis of Ebola virus disease-associated uveitis is unknown, we believe that the severe, acute panuveitis that developed in our patient was a direct cytopathic effect of active replication of Ebola virus persisting in an immune-privileged organ,” the researchers write. “The acute onset of symptoms, unilateral location, and extreme elevation of intraocular pressure that were seen in our patient are clinical findings similar to infectious uveitis syndromes caused by herpesviruses, in which the pathogenesis is known to be a direct consequence of active viral replication.”

    According to the New York Times, the virus also turned the man's eyes from blue to green. 


    Related: High IOP, corneal edema—is herpetic disease the culprit?


    What this means for ECPs

    “The medical community has appreciated that the Ebola virus can remain viable in some body fluids for an extended period of time after the initial onset of the disease,” says Russell N. Van Gelder, MD, PhD, president of the American Academy of Ophthalmology and a uveitis specialist. “This remarkable case now demonstrates that the virus can remain viable in ocular fluids long after the patient has recovered from the systemic infection. 

    Managed Healthcare Executive: Ebola’s lessons

    In a statement, the American Academy of Ophthalmology says the newest findings that indicate uveitis may be associated with active virus within the eye highlight the importance of safety measures eyecare professionals when performing invasive procedures such as intraocular injections or surgery for cataracts or glaucoma on patients who have been infected with the Ebola virus.

    “If the Ebola epidemic continues, ophthalmologists throughout the world will be seeing patients with post-Ebola uveitis, will need to recognize and treat this condition and will need to take appropriate increased precautions in performing surgical procedures on these patients,” says Dr. Gelder. “However, I want to emphasize that as far as we know, the Ebola virus is not transmitted by casual contact. The current study does not suggest that infection can be transmitted through contact with tears or the ocular surface of patients who have recovered from their initial infection.”

    Next: Diagnosing DR via telemedicine 

    Colleen E. McCarthy
    Colleen McCarthy is a freelance writer based in the Cleveland area and a former editor of Optometry Times. She is a 2010 graduate of the ...


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