Eales Disease

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2019-11-30
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Eales Disease is a type of obliterative vasculopathy, also known as angiopathia retinae juvenilis, periphlebitis retinae, primary perivasculitis of the retina. It was first described by the British ophthalmologist Henry Eales (1852–1913) in 1880 and is a rareocular disease characterized by inflammation and possible blockage of retinal blood vessels, abnormal growth of new blood vessels (neovascularization), and recurrent retinal and vitreal hemorrhages. Eales Disease with a characteristic clinical picture, fluorescein angiographic finding, and natural course is considered a specific disease entity.

Presentation

Patients are often asymptomatic in the initial stages of retinal perivasculitis. Some may develop symptoms such as floaters, blurring vision, or even gross diminution of vision due to massive vitreous hemorrhage. Vision in these patients can be normal to hand movements or light perception only. Bilaterality is quite common (50–90%) in patients.

Aetiology

The cause of this condition is not known. However, in a significant number of patients, DNA of the bacterium Mycobacterium tuberculosis has been detected by PCR.

Pathology

It is characterized by three overlapping stages of venous inflammation (vasculitis), occlusion, and retinal neovascularization.

Diagnosis

Diagnosis of Eales Disease is mainly clinical with exclusion.

Treatment

Treatment of Eales Disease comprises:

1. Medical treatment: A course of oral corticosteroids for extended periods is the main stay of treatment during active inflammation. A course of antitubercular therapy has also been recommended in selective cases.

2. Laser photocoagulation of the retina is indicated in stage of neovascularizion.

3. Vitreoretinal surgery is required for nonresolving vitreous haemorrhage and tractional retinal detachment. •If active TB is present - treat with ATT •otherwise manage the vitreous hemorrhage - Partial h’ge - postural management with propped up position Total h’ge - Pars Plana Vitrectomy

Epidemiology

Eales Disease most commonly affects healthy young adults. Male predominance (up to 97.6%) has been reported in a majority of the series, however one study reported that men and women are affected equally. The predominant age of onset of symptoms is between 20 and 30 years. The disease is now seen most commonly in the Indian subcontinent and its global incidence appears to be declining, probably largely due to improved public health and nutrition.