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Post-Ebola syndrome poses threat of ocular complications
Ebola hemorrhagic fever is a deadly disease caused by several species of Ebolavirus, a RNA virus of the Filoviridae family. This virus outbreak continues to affect different parts of Africa, and an outbreak reported in the Democratic Republic of the Congo in 1995 had only 71 survivors out of 316 cases. Human-to-human transmission is known to occur through exposure to body fluids. The current outbreak, which began in 2014, affected a greater number of people than ever before. The disease usually starts with nonspecific findings such as fever, weakness, diarrhea, vomiting, abdominal pain, headaches and myalgias, and in severe cases can lead to hemorrhagic manifestations.
Ocular perspective
Ocular signs have been observed in both the acute and late phases of the disease. Conjunctival injection and subconjunctival hemorrhage are seen in most infected patients and often have a bilateral presentation. Patients who have been infected with Ebolavirus follow one of two pathways: Either they succumb to a more intense hemorrhagic state, or they enter a convalescent phase in which subacute or chronic ophthalmic manifestations gain importance in the form of anterior uveitis, posterior uveitis or panuveitis.
Dennis S.C. Lam
How to tackle Ebola and eye complications
The Zaire ebolavirus species was responsible for the current Ebola hemorrhagic fever outbreak, which has infected more people than ever previously recorded. The threat of the disease spreading to other continents makes it increasingly important for medical professionals in every arena to become familiar with its signs and symptoms. Thus, the ophthalmic community has to be on high alert whenever coming in contact with patients suffering from fever and subconjunctival hemorrhage or congestion with a recent history of international travel to Ebola-affected countries. These patients should be transferred to a tertiary care center for serologic testing and quarantined if required. Patients entering the convalescent phase of the disease should also be followed up for evidence of uveitis.
Topical steroids and cycloplegic drugs have been proven to be effective in most cases of post-Ebola uveitis, but further investigation into the natural history and long-term effects of this disease are warranted. As the Ebola virus is transmitted by contact with body fluids, health care workers should wear personal protective equipment covering all skin, the face and eyes. According to recommendations from the U.S. Centers for Disease Control and Prevention, a trained observer should be present for all steps to ensure adherence to the strict protocol. The Ebola virus can be killed with hospital-grade disinfectants, and thus all equipment in contact with the patient needs to be sterilized or disposed of appropriately. A complete ophthalmic check-up beginning with visual acuity and examination of the anterior and posterior segments is mandatory to look for any signs of the Ebola virus in the eyes. Although a general ophthalmic examination can be safe, the active virus still persists in the aqueous humor, so any ocular surgery is a potential risk factor for exposure to the virus.
Click here to read the full commentary from Dennis S.C. Lam, MD, FRCOphth, and Sudipta Das, MD, published in Ocular Surgery New APAO Edition, November/December 2015.