Keep an eye, viral fevers can affect your vision too!

Bengaluru: A 48-year-old man from Bhatkal, Uttara Kannada, who had an acute loss of vision in his left eye, was brought to a city hospital a few weeks ago.

On clinical eye evaluation, doctors found that the patient could recognise only hand movements. He had anterior chamber inflammation with fundus evaluation showing features of neuroretinitis (inflammation of the optic nerve and adjoining retina). Systemic and laboratory investigations revealed that he was positive for Chikungunya IgM antibodies, while the other cause of neuroretinitis was ruled out.

The patient had a history of sudden onset of high-grade fever with chills, headache, malaise, arthralgia or arthritis, vomiting, myalgia, skin rash and low back pain which had occurred a month previous to his treatment for the eye ailment. Immediate systemic steroid therapy helped the patient restore his vision.

Doctors said that early detection and diagnosis helped this patient, but not many are aware that after a bout of viral illness, there could be problems related to vision and in some cases, it might even lead to vision loss.

A study conducted by Narayana Nethralaya revealed that eye-related problems are common during viral illnesses. The study covered 205 eyes of 119 patients across age groups of 6 to 77. The study found out that the patients developed ocular symptoms after a latent period of four days to eight weeks of the fever (mean 18.36 days).

Explaining the nature of this vision loss and its causes, Dr. K. Bhujang Shetty, Chairman and Managing Director, Narayana Nethralaya, said, “Patients have developed temporary or permanent loss of vision, following viral illnesses like dengue and chikungunya and bacterial infections like typhoid and rickettsia. This can occur many days to weeks, following the onset and resolution of the fever. The permanent vision loss could be due to optic neuritis, retinitis, and vascular occlusions. Early recognition and prompt treatment are the keys to managing these eye conditions.”

He said that they are proposing to conduct a prospective study on Fever Associated Visual Outcome involving Uvea and Retina (FAVOUR) following these illnesses. “The ethics committee has approved to recruit the patients for this study. Our Uvea consultant Dr Sanjay Srinivasan is the lead investigator along with the other consultants in the department,” Dr Shetty said.

Dr Padmamalini M., Head of the Department of Uvea and Ocular Immunology at Narayana Nethralaya, an expert in treatment of ocular manifestations of chikungunya, dengue, rickettsiae infections in the eye, said, “Once we identify the exact etiology and early institution of appropriate anti-inflammatory therapy with antimicrobial therapy we can restore the vision in majority of the patients.”

Dr Shetty said that awareness among people is the key to recognising and seeking the services of ophthalmologists for better outcomes and effective management of the condition.