August 2019

NEWS

Research Highlight
Visual consequences of measles


by Maxine Lipner EyeWorld Senior Contributing Writer



“Measles is highly communicable and highly infectious, and this can all be prevented by two doses of a safe and effective vaccine.”
—Brian Toy, MD

 

Although the Centers for Disease Control and Prevention proclaimed that measles had been eliminated from the U.S. in 2000, this past year they reported more than 1,000 cases nationwide, according to Brian Toy, MD. These cases are not limited to the purview of internists, since measles can have ocular ramifications.
“The classic presentation of measles includes the 3 Cs: cough, coryza, and conjunctivitis,” Dr. Toy said, adding that measles is spread by aerosolized particles, which infect mucous membranes. That triad of symptoms presents with fever a week or two after initial infection with the virus.
In general, physicians today may not be familiar with measles, Dr. Toy said. If a patient presents with conjunctivitis together with a cough, runny nose, then a fever, it’s important to be mindful that it could be a case of measles, he stressed.
Treatment for measles conjunctivitis and keratitis involves supportive care, such as making sure that there’s no breakdown of the corneal epithelium, which can lead to secondary infection of the cornea and cause scarring, Dr. Toy said. This means keeping the eyes lubricated with artificial tears or ointments. If the epithelium does break down, patients should be started on antibiotic ointments, ensuring good lid closure and treating other comorbid conditions (such as vitamin A deficiency) that could exacerbate the infection.
More severe complications, measles retinopathy and optic neuritis, can go hand in hand with the infection. “The classic findings are a diffuse retinitis and profound vision loss within 6 to 12 days after onset of the classic presentation of measles. A pigmentary retinopathy develops as the acute infections resolves, described as a salt and pepper fundus,” Dr. Toy said. This condition can be spotted with a dilated fundus exam, he said, adding that patients are asymptomatic even though the condition can lead to vision loss. While not much can be done for this severe complication, Dr. Toy pointed out that knowing such retinopathy has occurred can be helpful from a prognostic point of view. “It oftentimes can occur in conjunction with a cerebral infection, encephalitis, so if we detect a retinitis or pigmentary retinopathy, then we may send the patient either to the emergency room if they’re acutely altered, or to see their family care doctor or neurologist to evaluate for a central nervous system infection with measles,” Dr. Toy said.
In cases where patients are pregnant, the measles virus can be transmitted through the placenta, he warned. “The same parts of the eye that are affected in grown humans can be affected in a fetus,” he said. In this way, the fetus can be impacted by conjunctivitis, keratitis, potential scarring of the cornea, and even infection of the retina or optic nerve can occur. “There is such a big push toward vaccination because all of this can be prevented by appropriate vaccination,” Dr. Toy said.
For pregnant women and others who may realize that they have been exposed to the measles, use of immunoglobulin against the measles can be a helpful treatment if it’s administered within a short period after contact. “But because the incubation period of measles is 1 to 2 weeks, and this treatment has to be given within 48 to 72 hours of exposure, patients may not present with symptoms within the time window for the treatment to be effective,” he said. “So there is a very limited subset that this would be helpful to treat.”
In some parts of the world, use of vitamin A may have a role. “Not so much in the U.S. [is this used] but internationally where the prevalence of vitamin A deficiency or malnutrition is higher, causing more severe complications of measles,” Dr. Toy said, adding that in such cases if patients are hospitalized, they may be given vitamin A.
Overall, Dr. Toy stressed the need for vaccination. “Measles is highly communicable and highly infectious, and this can all be prevented by two doses of a safe and effective vaccine,” he said.

About the doctor

Brian Toy, MD
Assistant professor of clinical ophthalmology
USC Roski Eye Institute
Keck School of Medicine
University of Southern California
Los Angeles

Financial interests

Toy
: None

Contact information

Toy
: brian.toy@med.usc.edu

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