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    Acute viral maculopathy linked with hand, foot, and mouth disease

    ODs must be able to make this diagnosis



    Hand, foot, and mouth (HFM) disease is a condition caused by an enteroviruses most commonly coxsackievirus A16.1 HFM affects humans and should not be confused for foot-and-mouth (or hoof-and-mouth disease), which affects cloven-hoofed animals such as pigs and cows and is not a human disease.

    The virus is usually spread by sneezing and coughing by the carrier or through oral secretions or blister fluid. Although most affected are young children, adults can be afflicted by the disease.

    Typical symptoms include:

    • Fever

    • Sore throat

    • Malaise

    • Loss of appetite

    • Painful oral cavity blisters

    • Red rash without itching affecting palm of the hand, sole of the foot, and sometimes buttocks

    Systemic complications include viral meningitis and encephalitis.

    There is no specific therapy other than supportive treatment of symptoms.1,2

    Acute viral maculopathy has been reported associated with HFM. In most cases, the condition is unilateral. 

    Related: What we can learn from managing diabetic patients

    Initially, a circular area of mild gray discoloration of the macula may be noted followed by granular hyperpigmentation of the retinal pigment epithelium. The condition may present in one or both eyes. 

    There is no recommended treatment for HFM itself, and the condition is self-limiting.1

    The use of systemic corticosteroids is controversial;3,4 however, Agrawal et al reported visual improvement in their presented case.4

    Steroid therapy was not considered in this case because the patient had presented well beyond the acute phase of the disease with the expected outcome of profound vision loss.


    1. Mayo Clinic. Hand-foot-and-mouth disease. Available at: http://www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease/basics/definition/con-20032747. Accessed 4/10/17.

    2. Centers for Disease Control and Prevention. Hand, Foot, and Mouth Disease (HFMD). Available at: www.cdc.gov/hand-foot-mouth. Accessed 4/10/17.

    3. Haamann P, Kessel L, Larsen M. Monofocal outer retinitis associated with hand, foot, and mouth disease caused by coxsackievirus. Am J Ophthalmol. 2000 Apr;129(4):552-3.

    4. Agrawal R,  Bhan K,  Balaggan K, Lee RW, Pavesio CEAddison PK. Unilateral acute maculopathy associated with adult onset hand, foot and mouth disease: case report and review of literature. J Ophthalmic Inflamm Infect. 2015 Feb 1;5:2.

    Read more from Dr. Rafieetary here

    Mohammad Rafieetary, OD, FAAO
    Dr. Mohammad Rafieetary is a consultative optometric physician at the Charles Retina Institute in Memphis. He is a fellow of the ...


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