*Shankar is a 35 years old architect who recently came to Advanced Eye with complaints of seeing floaters in his right eye since a month. He had never suffered any eye injury or pain or redness in his eyes. In fact, Shankar had never even used glasses in his entire life! This sudden new development soon went from being a mild irritation to a real concern.

Normal Vision; but…

When Shankar’s eyes were examined, his eyes were found to have normal vision for near as well as distance vision. The front portion of his eyes were also found to be normal as were his eye pressures. When Dr Yogesh Patil, Retina Specialist at Advanced Eye Hospital, checked the back of Shankar’s eyes by Fundus Examination, he found his left eye to be normal. However, his right eye revealed inflammation in tissues around the veins in the retina (the photosensitive layer at the back of the eye) along with many superficial bleeding spots in the retina. Now, Shankar’s concern turned to fear. Bleeding in his eyes!?

 

 

More Unusual Testing:

Dr Yogesh Patil advised Shankar to undergo testing for Tuberculosis (Mantoux and Tuberculin Gold Tests). Shankar underwent these tests very sceptically. After all, how could he have TB? And how could his vision be related to it? But Shankar had to bite the bullet when the tests came back strongly positive. Dr Yogesh Patil gently explained to Shankar what was wrong with his eyes and what the plan of treatment would be. He then consulted with a chest physician and Shankar was started on treatment for TB: AKT followed by steroids a couple of weeks later.

New Vessels Grow:

When Shankar came back after 3 months, his vision continued to remain normal for near and distance vision. Fundus examination now revealed that the inflammation had healed (called healed vasculitis). However, when the Fundus Fluorescein Angiography test was done, it showed many New Vessels Elsewhere (NVE) which are abnormal new blood vessels that grow on the retina. Hence, Dr Yogesh Patil advised Shankar to undergo Peripheral Retinal Photocoagulation, a procedure where laser treatment is done to stop the growth of new blood vessels.

 

Fundus Fluorescein Angiography test

 

3 Months later:

When Shankar came back 3 months later, his vision remained normal and fundus examination showed healed inflammation with scars from the PRP procedure’s healing. Shankar’s relief knew no bounds when Dr Patil told him that this time, there was no growth of new blood vessels.

 

Take Home Message:

Shankar was diagnosed as having Eales Disease. In Eales Disease, there is inflammation of the vein which leads to blockage of the blood vessels and hence lack of blood supply to the retina, growth of new blood vessels and leaking of blood from these abnormal blood vessels. This usually affects males between the age of 25 – 40 years of age. Various theories have been proposed as to the cause. Tuberculosis and increased sensitivity to the TB protein are the most commonly accepted causes. Several studies in India have suggested that this is the same as the inflammation of blood vessels occurring due to TB. Hence this should be treated with AKT and steroids for a short term.

 

* Name changed to protect privacy