Ophthalmic Manifestations of Measles

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Disease Entity

Measles is a leading cause of childhood blindness worldwide. (1)


Etiology

Measles is caused by the morbillivirus, which is part of the family Paramyxoviridae. It usually affects children. 4 phases: incubation, invasion, eruption, and desquamation. (2)


Risk Factors

Poor access to measles vaccination and malnutrition correlates with higher rates of blindness in affected countries (2). Malnutrition is specifically due to vitamin A deficiency.

General Pathology

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Pathophysiology

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Primary prevention

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Diagnosis

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History

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Physical examination

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Signs

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Symptoms

Ophthalmologic manifestations are rare, however, can cause conjunctivitis and keratitis.

-Conjunctivitis- occurs early in the disease and is a hallmark symptom with a fever, runny nose, and cough before a rash emerges (2).

-Keratitis, is a much more severe condition of infection of the cornea. This can lead to a foreign body sensation and cause temporary vision loss. If scarring occurs then the loss of vision will be permanent. (2).

-Corneal scarring - corneal ulcers can form on the front of the eye and can be infected by the measles virus or bacterial infection that is secondary to measles. It is treated with topical antiviral or antibiotic drops, and if the ulcer doesn’t heal and can scar over and cause vision loss and blindness. (2).

-Optic neuritis - A rare complication that occurs due to measles. Acute cases can be treated with corticosteroids. Similar to retinitis, temporary or permanent vision loss can occur. (2).

-Blindness - Blindness from optic neuritis and corneal scarring can occur from lack of treatment and corneal scarring from malnutrition. (2).

Corneal involvement can cause the most issues as it can lead from a superficial punctate keratitis to corneal perforation.


Clinical diagnosis

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Diagnostic procedures

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Laboratory test

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Differential diagnosis

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Management

There is no antiviral treatment for measles, thus vaccination is the best prevention method for this disease.

“The Centers for Disease Control and Prevention (CDC) and the World Health Organization recommend measles vaccination (often administered in the United States through a shot for measles, mumps and rubella, or "MMR") to children age 1 and older and adults born in 1957 or later who do not display measles immunity. ” 2


For children with severe cases of measles, the World Health Organization recommends vitamin A treatment on the day of diagnosis and the day after to prevent vision loss. (3)


General treatment

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Medical therapy

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Medical follow up

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Surgery

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Surgical follow up

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Complications

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Prognosis

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Additional Resources

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References

Issam Eddine E, Sana S, Achraf F, Chiraz A, Walid Z. Manifestations oculaires de la rougeole chez l’adulte : à propos de trois cas [Ocular manifestations of measles in adults: About three cases]. J Fr Ophtalmol. 2020;43(5):392-396. doi:10.1016/j.jfo.2019.06.029 Dang S. Six ways measles can affect the eyes. American Academy of Ophthalmology. https://www.aao.org/eye-health/tips-prevention/six-ways-measles-can-affect-eyes-2. Published March 5, 2015. Accessed July 19, 2022. Measles vaccines: WHO position paper – April 2017. Note de synthèse de l’OMS sur les vaccins contre la rougeole – avril 2017. Wkly Epidemiol Rec. 2017;92(17):205-227. Published 2017 Apr 28. Moss WJ, Ota MO, Griffin DE. Measles: immune suppression and immune responses. Int J Biochem Cell Biol. 2004;36(8):1380-1385. doi:10.1016/j.biocel.2004.01.019

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