What are the Symptoms of Eales Disease

Eales disease

What is Eales Disease?

Eales disease (ED) is a rare ophthalmic disease characterized by three phases: vasculitis, occlusion, and retinal neovascularization, which leads to recurrent vitreous hemorrhage and loss of vision.

How is the disease progressing?

The age of presentation is around 20 to 30 years old, although Eales disease can also occur in adolescents. ED is characterized by three consecutive vascular responses that determine the course of the disease:

  • Inflammation (peripheral retinal periflebitis);
  • Occlusion (peripheral retina not supplied with blood);
  • Neovascularization of the optic nerve head or retina, which often leads to vitreous hemorrhage.

The first two stages are usually asymptomatic, while vitreous hemorrhage (often sudden and unilateral) is characterized by small spots, airborne particles, "cobwebs" and a decrease in visual acuity (which often remits). In 50 to 90 percent of cases, the second eye is affected within three to ten years. Recurrences are common.

Symptoms of Eales Disease

Recurrent bleeding leads to traction detachment of the retina, tearing of the retina and the formation of the epimacular membrane. Other patients may have mild visual impairment associated with retinal vasculitis (without vitreous hemorrhage). In addition, headaches, fluctuations in peripheral blood flow, dyspepsia, chronic constipation and epistaxis can occur.

What is the diagnosis based on?

Diagnosis is based on fluorescein ocular angiography (FEA) determinations, which can reveal early changes such as periflebitis, vascular lining, or lack of peripheral perfusion and neovascularization. Wide field angiography is useful for detecting peripheral retinal lesions.

Ultrasound is used to rule out associated retinal detachment, and optical coherence tomography provides high-resolution images of the retina.

What treatment methods are there?

Disease management is symptomatic and depends on the stage of the disease. It includes periodic assessment (in the regressive phase of periphlebitis or recent vitreous hemorrhage), the use of steroids (periocular or systemic injections), and anti-tuberculosis drugs (in the active phase of periphlebitis).

Laser photocoagulation is used in cases of retinal neovascularization or in areas where perfusion of the thick capillaries does not occur. Vitreous surgery is indicated in the case of unresolved vitreous hemorrhage (usually> 3 months).

Isolated episodes of vitreous hemorrhage can usually be stabilized without causing visual deficit. However, some patients may experience significant vision loss due to recurrent episodes of vitreous hemorrhage, macular changes, and tractive or combined retinal detachment that affects the macula. Blindness due to ED is rare. No disease-associated mortality has been reported.

 

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