How to detect early signs of eye disease in the eyes

Early Signs of Heart Diseases Appear in the Eyes

According to experts, Eye doctors may be able to detect signs of heart disease during a comprehensive eye exam. A new study finds that people with heart disease tend to have retinas marked by evidence of eye stroke.

Eye strokes happen when the eye is deprived of blood flow and oxygen, causing cells to die. This creates a mark, called a retinal ischemic perivascular lesion. These marks can be spotted when eye doctors run optical coherence tomography, or OCT is order to take a closer look at the retina.

OCT scans of the retina are valuable ways to detect disease and dysfunction in all parts of the body — not just the eyes. Eye scans can detect signs of Alzheimer’s, Parkinson’s and other underlying health conditions.

How eye exams can detect heart disease

The eye is the only place in the body where a doctor can see the live action of blood vessels, nerves and connecting tissue without relying on an invasive procedure. That’s why eye doctors are often the first to detect health conditions including high blood pressure, high cholesterol, stroke and more.

While the marks left behind by eye strokes may be present in low numbers in healthy people, those with heart disease tend to have a far greater number. Researchers arrived at these results by reviewing the medical records of 84 people with heart disease and 76 healthy people, all of whom had received a retinal OCT scan.

Tips to prevent vision loss

Follow these simple guidelines for maintaining healthy eyes well into your golden years.

Your eyes are an important part of your health. You can do many things to keep them healthy and make sure you’re seeing your best. Follow these simple guidelines for maintaining healthy eyes well into your golden years.

Have a comprehensive dilated eye exam. You might think your vision is fine or that your eyes are healthy, but visiting your eye care professional for a comprehensive dilated eye exam is the only way to really be sure. When it comes to common vision problems, some people don’t realize they could see better with glasses or contact lenses. In addition, many common eye diseases, such as glaucoma, diabetic eye disease, and age-related macular degeneration, often have no warning signs. A dilated eye exam is the only way to detect these diseases in their early stages.

During a comprehensive dilated eye exam, your eye care professional places drops in your eyes to dilate, or widen, the pupil to allow more light to enter the eye—the same way an open door lets more light into a dark room. This process enables your eye care professional to get a good look at the back of the eyes and examine them for any signs of damage or disease. Your eye care professional is the only one who can determine if your eyes are healthy and if you’re seeing your best.

Maintain your blood sugar levels. 90% of blindness caused by diabetes is preventable. Ask your health care team to help you set and reach goals to manage your blood sugar, blood pressure, and cholesterol—also known as the ABCs of diabetes.

  • A1c: The goal set for many people is less than 7% for this blood test, but your doctor might set different goals for you.
  • Blood pressure: High blood pressure causes heart disease. The goal is less than 140/90 mmHg for most people, but your doctor might set different goals for you.
  • Cholesterol: LDL or “bad” cholesterol builds up and clogs your blood vessels. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels. Ask what your cholesterol numbers should be.

Know your family’s eye health history. Talk to your family members about their eye health history. It’s important to know if anyone has been diagnosed with an eye disease or condition, since many are hereditary. This information will help to determine if you’re at higher risk for developing an eye disease or condition.

Eat right to protect your sight. You’ve heard that carrots are good for your eyes. But eating a diet rich in fruits and vegetables—particularly dark leafy greens, such as spinach, kale, or collard greens—is important for keeping your eyes healthy, too.i Research has also shown there are eye health benefits from eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut.

Maintain a healthy weight. Being overweight or obese increases your risk of developing diabetes and other systemic conditions, which can lead to vision loss, such as diabetic eye disease or glaucoma. If you’re having trouble maintaining a healthy weight, talk to your doctor.

Wear protective eyewear. Wear protective eyewear when playing sports or doing activities around the home. Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for the activity in which you’re engaged. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. Many eye care providers sell protective eyewear, as do some sporting goods stores.

Quit smoking or never start. Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to an increased risk of developing age-related macular degeneration, cataract, and optic nerve damage, all of which can lead to blindness.ii, iii

Be cool and wear your shades. Sunglasses are a great fashion accessory, but their most important job is to protect your eyes from the sun’s ultraviolet rays. When purchasing sunglasses, look for ones that block out 99 to 100 percent of both UV-A and UV-B radiation.

Give your eyes a rest. If you spend a lot of time at the computer or focusing on any one thing, you sometimes forget to blink and your eyes can get fatigued. Try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This short exercise can help reduce eyestrain.

Clean your hands and your contact lenses—properly. To avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect contact lenses as instructed and replace them as appropriate. Learn more about keeping your eyes healthy while wearing contact lenses and listen to a podcast on keeping your eyes safe.

Practice workplace eye safety. Employers are required to provide a safe work environment. When protective eyewear is required as a part of your job, make a habit of wearing the appropriate type at all times, and encourage your coworkers to do the same.

Eye care and safety tips

Your eyes are an important part of your health. Most people rely on their eyes to see and make sense of the world around them. But some eye diseases can lead to vision loss, so it is important to identify and treat eye diseases as early as possible. You should get your eyes checked as often as your health care provider recommends it, or if you have any new vision problems. And just as it is important to keep your body healthy, you also need to keep your eyes healthy.

Eye Care Tips

There are things you can do to help keep your eyes healthy and make sure you are seeing your best:

  • Eat a healthy, balanced diet. Your diet should include plenty or fruits and vegetables, especially deep yellow and green leafy vegetables. Eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut can also help your eyes.
  • Maintain a healthy weight. Being overweight or having obesity increases your risk of developing diabetes. Having diabetes puts you at higher risk of getting diabetic retinopathy or glaucoma.
  • Get regular exercise. Exercise may help to prevent or control diabetes, high blood pressure, and high cholesterol. These diseases can lead to some eye or vision problems. So if you exercise regularly, you can lower your risk of getting these eye and vision problems.
  • Wear sunglasses. Sun exposure can damage your eyes and raise your risk of cataracts and age-related macular degeneration. Protect your eyes by using sunglasses that block out 99 to 100% of both UV-A and UV-B radiation.
  • Wear protective eye wear. To prevent eye injuries, you need eye protection when playing certain sports, working in jobs such as factory work and construction, and doing repairs or projects in your home.
  • Avoid smoking. Smoking increases the risk of developing age-related eye diseases such as macular degeneration and cataracts and can damage the optic nerve.
  • Know your family medical history. Some eye diseases are inherited, so it is important to find out whether anyone in your family has had them. This can help you determine if you are at higher risk of developing an eye disease.
  • Know your other risk factors. As you get older, you are at higher risk of developing age-related eye diseases and conditions. It is important to know you risk factors because you may be able to lower your risk by changing some behaviors.
  • If you wear contacts, take steps to prevent eye infections. Wash your hands well before you put in or take out your contact lenses. Also follow the instructions on how to properly clean them, and replace them when needed.
  • Give your eyes a rest. If you spend a lot of time using a computer, you can forget to blink your eyes and your eyes can get tired. To reduce eyestrain, try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds.

Eye Tests and Exams

Everyone needs to have their eyesight tested to check for vision and eye problems. Children usually have vision screening in school or at their health care provider’s office during a checkup. Adults may also get vision screenings during their checkups. But many adults need more than a vision screening. They need a comprehensive dilated eye exam.

Getting comprehensive dilated eye exams is especially important because some eye diseases may not have warning signs. The exams are the only way to detect these diseases in their early stages, when they are easier to treat.

The exam includes several tests:

  • A visual field test to measure your side (peripheral) vision. A loss of peripheral vision may be a sign of glaucoma.
  • A visual acuity test, where you read an eye chart about 20 feet away, to check on how well you see at various distances
  • Tonometry, which measures your eye’s interior pressure. It helps to detect glaucoma.
  • Dilation, which involves getting eye drops that dilate (widen) your pupils. This allows more light to enter the eye. Your eye care provider examines your eyes using a special magnifying lens. This provides a clear view of important tissues at the back of your eye, including the retina, macula, and optic nerve.

If you have a refractive error and are going to need glasses or contacts, then you will also have a refraction test. When you have this test, you look through a device that has lenses of different strengths to help your eye care professional figure out which lenses will give you the clearest vision.

At what age you should start getting these exams and how often you need them depends on many factors. They include your age, race, and overall health. For example, if you are African American, you are at higher risk of glaucoma and you need to start getting the exams earlier. If you have diabetes, you should get an exam every year. Check with your health care provider about if and when you need these exams

Astigmatism

Astigmatism is a common vision condition that causes blurred vision. It occurs when the cornea (the clear front cover of the eye) is irregularly shaped or sometimes because of the curvature of the lens inside the eye.

An irregularly shaped cornea or lens prevents light from focusing properly on the retina, the light-sensitive surface at the back of the eye. As a result, vision becomes blurred at any distance. This can lead to eye discomfort and headaches.

Astigmatism frequently occurs with other vision conditions like myopia (nearsightedness) and hyperopia (farsightedness). Together these vision conditions are referred to as refractive errors because they affect how the eyes bend or “refract” light.

There are many causes to astigmatism. It can be hereditary and is usually present from birth. It can decrease or increase over time.

comprehensive optometric examination will include testing for astigmatism. If necessary, your optometrist can provide eyeglasses or contact lenses that correct the astigmatism by altering the way light enters the eyes.

Another option for treating astigmatism is a corneal procedure called orthokeratology (ortho-k). In this painless, noninvasive procedure, the patient wears a series of specially designed rigid contact lenses to gradually reshape the curvature of the cornea.

Laser surgery can also treat some types of astigmatism. The laser changes the shape of the cornea by removing a small amount of eye tissue.

Astigmatism

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What causes astigmatism?

Possible view through an astigmatic eye -- Image courtesy of Eyemaginations™

The curvature of the cornea and lens bends the light entering the eye in order to focus it precisely on the retina at the back of the eye. In astigmatism, the surface of the cornea or lens has a somewhat different curvature.

the surface of the cornea is shaped more like a football instead of round like a basketball, the eye is unable to focus light rays to a single point. Vision becomes out of focus at any distance.

In addition, the curvature of the lens inside the eye can change, resulting in an increase or decrease in astigmatism. This change frequently occurs in adulthood and can precede the development of naturally occurring cataracts.

Sometimes astigmatism may develop following an eye injury or eye surgery.

Astigmatism also occurs due to a relatively rare condition called keratoconus in which the cornea becomes progressively thinner and cone-shaped. This results in a large amount of astigmatism, which causes poor vision that cannot be clearly corrected with eyeglasses. People with keratoconus usually need contact lenses for clear vision and eventually may need a corneal transplant.

An optometrist can diagnose an astigmatism through a comprehensive eye examination. Testing for astigmatism measures how the eyes focus light and determines the power of any optical lenses needed to improve vision. This examination may include:

  • Visual acuity-When you read letters on a distance chart, you are measuring your visual acuity. Visual acuity is given as a fraction (for example, 20/40). The top number is the standardized testing distance (20 feet) and the bottom number is the smallest letter size read. A person with 20/40 visual acuity would have to get within 20 feet to read a letter that should be seen clearly at 40 feet. Normal distance visual acuity is 20/20.
  • Keratometry/Topography-A keratometer is the primary instrument used to measure the curvature of the cornea. By focusing a circle of light on the cornea and measuring its reflection, it is possible to determine the exact curvature of that area of the cornea’s surface. This measurement is particularly critical in determining the proper fit for contact lenses. A corneal topographer, which is gaining use, generates a contour map of the cornea and provides even more detail of the cornea’s shape.
  • Refraction-Using an instrument called a phoropter, your optometrist places a series of lenses in front of your eyes and measures how they focus light. This is performed using a handheld lighted instrument called a retinoscope or an automated instrument that evaluates the approximate focusing power of the eye. Based on your responses, the power is then refined to determine the lenses that allow the clearest vision. Despite improved technology, patient input remains integral in determining vision needs.

With the information from these tests, your optometrist can determine if you have astigmatism. Your optometrist will use these findings, combined with those of other tests performed, to determine the power of any lens correction you need to provide clear, comfortable vision. Once testing is complete, your optometrist can discuss treatment options.

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How is astigmatism treated?

Eyeglasses are the primary choice for persons with astigmatism.

People with astigmatism have several options to regain clear vision. They include:

  • Eyeglasses. People with astigmatism primarily choose eyeglasses to improve their vision. The eyeglasses contain a special cylindrical lens prescription that compensates for the astigmatism. This provides additional power in specific parts of the lens.

    Generally, a single-vision lens is prescribed to provide clear vision at all distances. However, patients over age 40 who have presbyopia may need a bifocal or progressive addition lens.

  • Contact lenses. Some people will have better vision with contact lenses rather than eyeglasses. Contact lenses may provide clearer vision and a wider field of view. However, since contact lenses are worn directly on the eyes, they require regular cleaning and care to safeguard eye health.

    Standard soft lenses may not be effective in correcting astigmatism. However, special toric soft contact lenses can correct for many types of astigmatism. Because rigid gas-permeable contact lenses maintain their regular shape while on the cornea, they can compensate for the cornea’s irregular shape and improve vision for people with astigmatism.

  • Orthokeratology. Orthokeratology (ortho-k) involves the fitting of a series of rigid contact lenses to reshape the cornea. The patient wears contact lenses for limited periods, such as overnight, and then removes them. People with moderate astigmatism may be able to temporarily obtain clear vision without lenses for most of their daily activities. Orthokeratology does not permanently improve vision. If patients stop wearing the retainer lenses, their vision may return to its original condition.
  • Laser and other refractive surgery procedures. Astigmatism can also be corrected by reshaping the cornea through LASIK (laser in situ keratomileusis) or PRK (photorefractive keratectomy). PRK removes tissue from the superficial and inner layers of the cornea. LASIK removes tissue only from the inner layer of the cornea.

If you have an astigmatism, you have a wide range of options to correct your vision problem. In consultation with your optometrist, you can select the treatment that best meets your visual and lifestyle needs

CORONA VIRUS AND YOUR EYES

Our eyes might play an important role in the spread and prevention of the new coronavirus outbreak seen throughout the world.

For example, a Peking University physician believes he may have contracted the coronavirus while not wearing eye protection when treating patients. Medical officials, though, say while this is possible, it may be unlikely.

To cut your personal risk of contracting the new coronavirus, avoid touching your eyes, nose or mouth with unwashed hands. It is the mucous membranes (membranes that line various cavities in the body) that are most susceptible to transmission of the virus.

What is coronavirus?

Reports of a new coronavirus (also referred to as COVID-19) first emerged in late December 2019 in Wuhan, China.

Coronaviruses are a group of common viruses. Some affect only animals (such as bats, cats, camels and cattle), while others also affect people, according to the U.S. National Library of Medicine.

COVID-19 can trigger ailments as minor as the common cold, or more consequential such as bronchitis, pneumonia and kidney failure. The most severe cases may be life-threatening. This is the seventh known type of coronavirus, according to the Centers for Disease Control and Prevention (CDC).

How is the new coronavirus related to your eyes?

Patients who have contracted the new coronavirus may have ocular symptoms.

Conjunctivitis is an inflammation of the membrane covering the eyeball. It is often referred to as “pink eye.” Conjunctivitis often presents as an infected/red, “wet and weepy” eye.

Viral conjunctivitis is known to present with upper respiratory infections (colds, flus, etc.) and may be a symptom of the COVID-19 virus. A recent study of hospitals across China, published in the New England Journal of Medicine , found “conjunctival congestion” or red, infected eyes in 9 of 1,099 patients (0.8%) with a confirmed diagnosis of coronavirus.

A study in The Journal of Medical Virology  of 30 patients hospitalized for COVID-19 had only one patient diagnosed with conjunctivitis. Based on this information, the occurrence of conjunctivitis is low.

IF YOU’RE NOT FEELING WELL… Call your family doctor. If you suspect you may have conjunctivitis, call an eye doctor near you. It is suggested that patients do not present to medical or eye care facilities without a prior phone call to help to decrease the possible spread of the virus. A phone call allows the health facility to prepare for your visit and diagnose and treat you in a proper manner.

The relationship between the transmission of the coronavirus and your eyes is complicated.

It’s thought that COVID-19 spreads from person to person mainly through airborne “respiratory droplets” produced when someone coughs or sneezes, much like the flu virus spreads, the CDC says. These droplets can land in the mouths or noses of people who are nearby, and possibly be inhaled into the lungs.

Medical experts are unsure whether someone can contract this virus by touching a surface or object, such as a table or doorknob, that has COVID -19 on it and then touching their mouth, nose or possibly their eyes.

Peking University respiratory specialist Wang Guangfa believes he contracted COVID-19 when he came into contact with patients at health clinics in China.

Wang reported that his left eye became inflamed afterward, followed by a fever and a buildup of mucus in his nose and throat. He subsequently was diagnosed with the new coronavirus.

According to the South China Morning Post , Wang thinks the virus entered his left eye because he wasn’t wearing protective eyewear.

Dr. Jan Evans Patterson , professor of medicine and pathology in the Long School of Medicine’s infectious diseases division at UT Health San Antonio, confirms that a scenario like Wang’s could potentially happen.

In Wang’s situation, she says, respiratory droplets from an infected person might have reached his eyes or other mucous membranes.

Generally, though, transmission of COVID-19 comes with so many unknowns that it’s “plausible but unlikely” to contract it through hand-to-eye contact, says Dr. Stephen Thomas , chief of infectious diseases at SUNY Upstate Medical University in Syracuse, New York.

How contagious is the new coronavirus?

Currently, it’s not known how “easily or sustainably” the virus spreads from person to person, according to the CDC.

Many large gatherings and events have been canceled or postponed as a public health measure to contain the spread of the new coronavirus. U.S. health officials have implemented these emergency measures as a best practice to contain the transmission of the virus.

Schools have canceled classes and switched to online courses, and sports leagues and museums have closed as a precaution to avoid community spread.

What are the symptoms of the new coronavirus?

Symptoms of COVID-19 include a mild to severe respiratory illness accompanied by a fever, cough and breathing problems, according to the World Health Organization . Other symptoms include runny nose, sore throat and headache.

Most people develop only mild symptoms. But some people, usually those who are older or have other medical complications, develop more severe symptoms, including pneumonia, which can be fatal.

Symptoms normally show up two to 14 days after someone has been exposed to the virus.

How is COVID-19 diagnosed?

Health care professionals diagnose the coronavirus through lab tests of respiratory or blood samples or other bodily fluids.

Is there a vaccine or treatment for the new coronavirus?

So far, no vaccine or antiviral treatment has been identified. Therefore, the best method for limiting the spread of this virus is to quickly isolate people who have it (or are presumed to have it if they’ve been exposed to it) before they infect others, the Harvard Business Review says.

How can you cut your risk of contracting coronavirus?

The Centers for Disease Control and Prevention (CDC) has established a site with the most up-to-date information related to the coronavirus outbreak .

The CDC’s recommended steps to prevent illness include:

Clean your hands often

Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, eaten, used the restroom, blown your nose, coughed or sneezed.Avoid touching your eyes, nose and mouth as much as possible, but especially with unwashed hands.

Reduce your exposure

Avoid close contact with people who are sick.Stay home if you’re sick — except to get medical care.

Cover coughs and sneezes

Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow.Throw used tissues in the trash.Immediately wash your hands with soap and water for at least 20 seconds.Wear a face mask that covers your mouth and nose if you are sick.

If you are NOT sick: You do not need to wear a face mask unless you are caring for someone who is sick (and they are not able to wear a face mask). Face masks may be in short supply and they should be saved for health care workers, people who are sick and caregivers.

Clean and disinfect surfaces

Current evidence suggests that novel coronavirus may remain viable for hours to days on surfaces made from a variety of materials, the CDC reports. Cleaning of visibly dirty surfaces followed by disinfection is a best practice measure for prevention of COVID-19 and other viral respiratory illnesses in households and community settings.

At least some coronavirus can potentially remain viable — capable of infecting a person — for up to 24 hours on cardboard and up to three days on plastic and stainless steel, The Washington Post  reports, citing research  by a laboratory that is part of the National Institute of Allergy and Infectious Diseases.

How to dress to limit exposure

According to the World Health Organization, if you have the potential of being exposed to a person with coronavirus, you should be equipped with protective eyewear, a surgical mask, medical gown, medical gloves and a disposable respirator.

For more information, call us on tel: 07030000001 or visit our website: eyeclinic.professional.com.ng

BILATERAL RETINITIS FOLLOWING TYPHOID FEVER

Abstract

Background

Post typhoid fever immune related reactions affecting the eye is a rare finding which can have various presentations in which typhoid retinopathy is not a well recognized sequelae.

Case presentation

Here we present a case of 59 year old male who presented with right eye sudden painless loss of vision 4 weeks after typhoid fever which was diagnosed and treated successfully. His BCVA was 2/60 in right eye and 6/6 in left eye. Fundus examination showed retinitis along with macular serous detachment in right eye and retinitis in left eye. Significant improvement in BCVA in right eye was observed after treatment with oral steroid with resolving retinitis lesions. Diagnosis of post typhoid immune mediated retinitis was made with good resolution following treatment.

Conclusions

Immune mediated retinitis is a rare sequelae to typhoid infection which can be successfully treated with systemic steroids with good resolution of the lesions.

Keywords: Post typhoid fever, Immune mediated, Typhoid retinopathy, Retinitis

Background

Typhoid or enteric fever is a systemic disease which is characterized by fever and abdominal pain caused due to dissemination of Salmonella typhi or paratyphi. It is transmitted by food or water due to fecal contamination by ill or asymptomatic chronic carriers. A high incidence of typhoid fever in developing countries correlates with poor sanitation and lack of access to clean drinking water []. Ocular manifestations of typhoid fever are rare and include lid edema or abscess, dacryoadenitis, conjunctival petechiae or chemosis, corneal ulceration, uveitis, vitreous haemorrhage, retinal haemorrhage and detachment, stellate maculopathy, pigmentary retinopathy, optic neuritis, internal or external ophthalmoplegia, orbital haemorrhage or abscess. These complications are caused either by direct invasion of the organisms into the ocular tissue, or by hypersensitivity reaction such as vitreous haemorrhage after typhoid vaccination []. Here we are presenting a case of retinitis with macular serous detachment developing post typhoid fever.

Case report

A 59 year old male presented to our hospital 1 week after experiencing diminution of vision in the right eye. He gave a history of typhoid fever 4 weeks prior to presentation for which Widal test was performed to confirm diagnosis. The test results showed significant titres for ‘O’ antigen (>1:80) and ‘H’ antigen (>1:160) and negative for ‘AH’ and ‘BH’ antigens. He was subsequently started on oral Ofloxacin 400 mg twice daily for 2 weeks following which fever subsided. There was no known history of diabetes mellitus or hypertension. On ocular examination his best corrected visual acuity was 2/60 in the right eye and 6/6 in left eye. Anterior segment findings were unremarkable with IOP being within normal range for both eyes. Fundus examination of right eye showed white fluffy lesions along the superior and inferior arcades with superficial haemorrhages in around the macula with a macular star suggestive of retinitis (Fig. 1a). Left eye fundus showed few dispersed retinitis lesions with superficial haemorrhage along the superior arcade with intact foveal reflex (Fig. 1b). On optical coherence tomography of right eye underlying macular serous retinal detachment was noted (Fig. 2a). Blood tests were done to rule out VDRL and HIV status. X-cyton analysis of the anterior chamber aspirate was negative for organisms like Mycobacterial Tuberculosis, Toxoplasma Gondii, Hepes Simplex Virus, Cytomegalovirus and Varicella Zoster Virus. After analysis of the reports diagnosis of post typhoid retinitis in both eyes was made. Patient was started on oral prednisolone 1 mg/kg body weight which was tapered over 2 months along with monitoring of systemic and ocular health. Patient came for follow up every 2 weeks for 3 months. Every visit fundus photo was documented. After 2 months of initiating treatment there was an improvement in the BCVA in right eye to 6/6 which was maintained on further visits. Fundus examination revealed resolving lesions in both eyes (Fig. 3a, b) and OCT of the right eye showed resolution of the serous detachment (Fig. 2b).

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a Fundus photo of right eye with white fluffy lesions suggestive of retinitis in the superior and inferior temporal arcades with macular star. b Fundus photo of left eye with white fluffy retinitis lesions in the superior temporal arcade

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a Pre treatment OCT of right eye suggestive of macular edema. b A normal OCT photo of right eye post treatment

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a Post treatment fundus photo of right eye showing resolved retinitis lesions with few dispersed hard exudates. b Post treatment fundus photo of left eye with resolved retinitis lesions

Retinitis is characterized by confluent areas of retinal whitening which progresses along the retinal blood vessels, often associated with intraretinal hemorrhages and hard exudates. A significant number of retinitis cases are thought to be idiopathic in etiology but a small proportion of cases are infectious in etiology such as Toxoplasma gondii (toxoplasmosis), Leptospira spp. (leptospirosis), Mycobacterium tuberculosis (tuberculosis) and other viral and fungal etiologies []. Non infectious causes of retinitis include sarcoidosis, Behcet’s disease. Infectious causes are usually unilateral and may be associated with mild vitritis. Patients can present with Neuroretinitis like picture with optic disc edema and macular hard exudates []. The macular star becomes prominent over first 3 weeks with neuroretinitis resolving over 6–8 weeks []. Leakage from the optic nerve head can lead to retinal swelling, exudation and edema, whereas retinal venous occlusion due to vasculitis results in intraretinal haemorrhage, cotton wool spots and retinal and optic nerve head edema []. It was postulated that microbial pathogens may be responsible for immune mediated ocular and systemic pathology through postinfectious immunological effects. These may be due to molecular mimicry eliciting an immune response that cross react with self antigens. Even though active infection is an unusual cause of retinal vasculitis, it is possible that many idiopathic and systemic disease associated cases are precipitated by previous encounters with microbes bearing DNA sequence homologous to retinal and vascular autoantigens. Similarity between S-antigen and peptides derived from yeast, E. coli, and Hepatitis B virus was found and there was an ability of these microbial peptides to elicit an immune response post infection []. Immune mediated retinitis is a clinical diagnosis most often when there is past history of infection few weeks or days prior to the onset of ocular manifestations. In this case, treatment with oral steroids was initiated due to inflammation of the retina, especially the macula which caused decrease in vision. By taking into consideration the time of onset of ocular presentation, previous history of typhoid fever and the response to oral steroids; the most likely diagnosis was post typhoid fever immune mediated retinitis with macular neurosensory detachment in the right eye and retinitis in left eye. In our case as the disc edema was not prominent, neuroretinitis was not considered as the diagnosis. Similar case reports by Relhan et al. [] and Laul et al. [] showed immune mediated response post typhoid fever presenting with neuroretinitis, vasculitis and macular detachment. Successful treatment with steroids was seen in them. Fusco et al. [] reported a case of bilateral chorioretinitis and stellate maculopathy post typhoid fever. However, in our case Xcyton analysis was done to rule out possible infectious retinitis before initiating steroid therapy, as it could exacerbate non immune mediated retinitis. Xcyton multiplex PCR analysis even though has the advantage of increasing the diagnostic yield it has certain disadvantages like false positive and negative results due to cross reactivity and preferential amplification, negative internal control if there is high amount of a particular target causing exhaustion of reagents and high cost.

Conclusion

Immune mediated retinitis can occur following systemic infection and can be managed with steroids followed by good resolution of the lesions. PCR analysis of the aqueous is a rapid diagnostic tool wherein multiple organisms can be detected and sight threatening bacterial and viral infections can be ruled out before initiation of steroid therapy.

Authors’ contributions

PM carried out AC tap for Xcyton analysis, did the manuscript editing and review, TT did the data acquisition, literature search and manuscript preparation, GG did the data acquisition and analysis and manuscript review, SA did the data acquisition and analysis. All authors read and approved the final manuscript.

Acknowledgements

None.

Competing interests

The authors declare that they have no competing interests.

Contributor Information

M. Prabhushanker, moc.liamg@reknahsuhbarprd.

Tasneem T. Topiwalla, moc.liamg@spotsat.

Geetha Ganesan, moc.liamg@nasenageeg.

Sripal Appandaraj, moc.liamg@rd.lapirs.

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EYE EXAM CAN BE USED TO DIAGNOSE CEREBRAL MALARIA

Cerebral malaria can be diagnosed by a simple eye examination, a method that is both quick and cheap and could save thousands of lives in malarial regions, a new study shows.

Diagnosing cerebral malaria — a severe complication of malaria in which the Plasmodium falciparum parasite infects capillaries that flow through the tissues of the brain — can be difficult, as patients can be unconscious and have a number of other illnesses.

Now researchers have found that certain changes on the retina, the light sensitive tissue at the back of the eye, are unique to severe forms of malaria.

This will enable doctors to determine whether a child is suffering from cerebral malaria or some other, unrelated illness, and prescribe immediate treatment accordingly.

The findings are published this week (6 November) in the American Journal of Tropical Medicine and Hygiene.

The team led by Nick Beare of the UK-based Royal Liverpool University Hospital analysed the retinas of 45 children admitted to hospital in Blantyre, Malawi with cerebral malaria.

They found that white opaque patches and whitened blood vessels on the retina were unique signs of cerebral malaria. Other signs include bleeding of the retina and swelling of the optic nerve.

The diagnosis only requires an instrument called an ophthalmoscope, which is commonly used in Africa for studying eye disease.

“Diagnosis requires special training in eye examination, but is relatively straightforward and cost effective, which is essential in resource-poor settings such as Africa,” says Beare.

His team suggests that the malaria parasites stick to the linings of the small blood vessels in the brain and eyes where they disrupt oxygen and nutrients supply, causing the unique whitening of blood vessels in the eye.

Richard Idro of the Kenya Medical Research Institute says that the specific nature of the changes in the eye makes them useful for differentiating between coma due to malaria and coma from other causes.

A multi-centre evaluation of the findings will be undertaken by researchers in Gabon, the Gambia, Ghana and Kenya. “If they prove useful, doctors will need to be trained in the recognition of these signs,” says Idro.

Willis Akhwale, head of the department of malaria control at Kenya’s Ministry of Heath, welcomed the study, but cautioned that it is vital to test the methodology to ensure that correct diagnosis is made so that malaria drugs are not prescribed for other illnesses.

 

WHAT IS GLAUCOMA?

Glaucoma is a condition that causes damage to your eye’s optic nerve and gets worse over time. It’s often linked to a buildup of pressure inside your eye. Glaucoma tends to be inherited and may not show up until later in life.

The increased pressure, called intraocular pressure, can damage the optic nerve, which transmits images to your brain. If the damage continues, glaucoma can lead to permanent vision loss. Without treatment, glaucoma can cause total permanent blindness within a few years.

Most people with glaucoma have no early symptoms or pain. You need to see your eye doctor regularly so she can diagnose and treat glaucoma before long-term visual loss happens.

If you’re over age 40 and have a family history of the disease, you should get a complete eye examfrom an eye doctor every 1 to 2 years. If you have health problems like diabetes or a family history of glaucoma or are at risk for other eyediseases, you may need to go more often.

What Causes Glaucoma?

It’s the result of an intrinsic deterioration of the optic nerve, which leads to high fluid pressure on the front part of the eye.

Normally, the fluid, called aqueous humor, flows out of your eye through a mesh-like channel. If this channel gets blocked, the liquid builds up. The reason for the blockage is unknown, but doctors do know it can be inherited, meaning it’s passed from parents to children.

Less common causes include a blunt or chemical injury to your eye, severe eye infection, blocked blood vessels inside the eye, and inflammatory conditions. It’s rare, but sometimes eye surgery to correct another condition can bring it on. It usually affects both eyes, but it may be worse in one than the other.

What Are the Types of Glaucoma?

There are two main kinds:

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Open-angle glaucoma. It’s the most common type. Your doctor may also call it wide-angle glaucoma. The drain structure in your eye — it’s called the trabecular meshwork — looks normal, but fluid doesn’t flow out like it should.

Angle-closure glaucoma. It’s less common in the West than in Asia. You may also hear it called acute or chronic angle-closure or narrow-angle glaucoma. Your eye doesn’t drain right because the drain space between your iris and cornea becomes too narrow. This can cause a sudden buildup of pressure in your eye. It’s also linked to farsightedness and cataracts, a clouding of the lens inside your eye.

Who Gets Glaucoma?

It mostly affects adults over 40, but young adults, children, and even infants can have it. African-Americans tend to get it more often, when they’re younger, and with greater vision loss.

You’re more likely to get it if you:

  • Are of African-American, Irish, Russian, Japanese, Hispanic, Inuit, or Scandinavian descent
  • Are over 40
  • Have a family history of glaucoma
  • Have poor vision
  • Have diabetes
  • Take certain steroid medications, like prednisone
  • Have had trauma to the eye or eyes

What Are the Symptoms?

Most people don’t have any. The first sign is often a loss of peripheral, or side, vision. That can go unnoticed until late in the disease. That’s why glaucoma is often called the “sneak thief of vision.”

Detecting glaucoma early is one reason you should have a complete exam with an eye specialist every 1 to 2 years. Occasionally, pressure inside the eye can rise to severe levels. In these cases, you may have sudden eye painheadache, blurred vision, or the appearance of halos around lights.

If you have any of the following symptoms, seek immediate medical care:

  • Seeing halos around lights
  • Vision loss
  • Redness in the eye
  • Eye that looks hazy (particularly in infants)
  • Nausea or vomiting
  • Eye pain
  • Narrowed vision (tunnel vision)

How Is It Diagnosed?

Your eye doctor will use drops to open (he’ll call it dilate) your pupils. Then he’ll test your vision and examine your eyes. He’ll check your optic nerve, and if you have glaucoma, it will look a certain way. He may take photographs of the nerve to help him track your disease over time. He’ll do a test called tonometry to check your eye pressure. He’ll also do a visual field test, if necessary, to figure out if you’ve lost your side, or peripheral, vision. Glaucoma tests are painless and take very little time.

How Is Glaucoma Treated?

Your doctor may use prescription eye drops, laser surgery, or microsurgery to lower pressure in the eye.

Eye drops. These either reduce the formation of fluid in the eye or increase its outflow, thereby lowering eye pressure. Side effects may include allergies, redness, stinging, blurred vision, and irritated eyes. Some glaucoma drugs may affect your heart and lungs. Be sure to tell your doctor about any other medications you’re taking or are allergic to.

Laser surgery. This procedure can slightly increase the flow of the fluid from the eye for people with open-angle glaucoma. It can stop fluid blockage if you have angle-closure glaucoma. Procedures include:

  • Trabeculoplasty: Opens the drainage area
  • Iridotomy: Makes a tiny hole in the iris to let fluid flow more freely
  • Cyclophotocoagulation: Treats areas of the middle layer of your eye to reduce fluid production

Microsurgery. In a procedure called a trabeculectomy, the doctor creates a new channel to drain the fluid and ease eye pressure. Sometimes this form of glaucoma surgery fails and has to be redone. Your doctor might implant a tube to help drain fluid. Surgery can cause temporary or permanent vision loss, as well as bleeding or infection.

Open-angle glaucoma is most often treated with various combinations of eye drops, laser trabeculoplasty, and microsurgery. Doctors in the U.S. tend to start with medications, but there’s evidence that early laser surgery or microsurgery could work better for some people.

Infant or congenital glaucoma — meaning you are born with it — is primarily treated with surgery, because the cause of the problem is a very distorted drainage system.

Talk to your eye doctor to find out which glaucoma treatment is right for you.

Can You Prevent Glaucoma?

No. But if you diagnose and treat it early, you can control the disease.

What’s the Outlook?

At this time, lost vision can’t be restored. However, lowering eye pressure can help preserve the sight you have. Most people with glaucoma who follow their treatment plan and have regular eye exams don’t go blind.