|Year : 1981 | Volume
| Issue : 1 | Page : 35-36
Acute haemorrhagic conjunctivitis-rare ocular manifestations
TA Alexander, Anna Thomas
Department of Ophthalmology, Christian Medical College, Vellore, India
T A Alexander
Department of Ophthalmology Christian Medical College Vellore- 633 001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Alexander T A, Thomas A. Acute haemorrhagic conjunctivitis-rare ocular manifestations. Indian J Ophthalmol 1981;29:35-6
The various ocular manifestations of ocute haemorrhagic conjunctivitis so for reported are episcleritis, phlyctens, follicular conjunctivitis, superficial marginal keratitis, epithelial erosions and sub epithelial keratitis. During the last epidemic in southern India a few of our cases presented with rare ocular features. The aim of this article is to report two cases of optic neuritis and one case of palsy of the 6th nerve which developed following an attack of viral conjunctivitis.
| CASE REPORT-1|| |
M.G.K. male aged fifty years presented to us with complaints of sudden diminution of of vision in right eye of two days duration. A week prior to this he had developed acute viral conjunctivitis in both eyes. During the attack he had low grade fever lasting for two days. On examination his visual acuity was hand movements in the right eye and 6/6 in the left eye. Right eye showed ill sustained pupillary reaction and ocular movements were restricted to abduction. Fundus examination revealed blurring of the disc margins, tortuosity of the vessels and superficial haemorrhages around the disc. Slit lamp examination showed a few cells in the vitreous. There was no other neurological deficit. A diagnosis of optic neuritis with 6th nerve palsy was made and the patient was put on systemic and retrobulbar injection of steroids. Within one week his visual acuity improved to 6/6 and ocular movements to full range. Central field examination done at 6/24 showed a central scotoma. Serum when tested against Coxakie A/54, Variant CH 24/1970 EV 70 viruses showed that antibody titre was significantly high (32) against CH 24/1970. All other investigations were normal.
| CASE REPORT-2|| |
P.D. female aged 53 reported with complaints of sudden diminution of vision in the right eye since one day. Her vision in the right eye was 6/24 with correction and left eye was hand movements (old retinal detachment). Four days prior to this the patient had acute conjunctivitis in both the eyes. The patient also had pain on moving the eye balls. Fundus examination revealed a normal aphakic fundus. A central scotoma was demonstrated on scotometry and a diagnosis of retrobulbar neuritis was made. Systemic and retrobulbar steroids and inj. Vitamin B complex were given. Two days later vision improved to 6/5. All investigations were normal sera tested against Coxakie A 24, Variant CH 24/1970, and EV 70. Neutralizing antibody titre was not high (less than 8) in all viruses.
| Discussion|| |
Acute haemorrhagic conjunctivitis is a relatively new clinical entity whose entire clinical features are not fully elucidated. Constitutional symptoms mainly are headache, fever, malaise and abdominal pain. Neurological complications of lumbar Radiculomyelitis with incomplete recovery were first reported from India from Bombay during 1971 epidemic., All the above cases except one had developed viral conjunctivitis immediately prior to the spinal involvement. Following this report Kono studied the neurotoxic effect of AHC virus in cyanomologous. He observed that following the inoculation of virus material into the spinal cord and thalamus, the monkeys developed paraplegia or monoplegia of the lower limbs. The frequent association of viral conjunctivitis and radiculomyelitis and experimental evidence of neurotoxicity suggests that AHC virus is capable of producing neurological complications.
Virological studies in our cases have shown that in case No. 1 there was high neutralizing antibody titre while case No. 2 did not have. Earlier observations in our laboratory have shown that there are cases of conjunctivitis with positive virus isolation and no significant neutralizing antibody. Hence one cannot rule out attacks of viral conjunctivitis even though there is no significant antibody titre.
The development of these ocular complications immediately following conjunctivitis suggests that the virus is likely to be responsible for these lesions. The ocular lesions recovered without any sequelae.
One must look for these ocular complications in cases of viral conjunctivitis. These ocular complications are rare, when compared to the number of cases of viral conjunctivitis. The emergence of virulent neurotoxic mutant strains are possibly responsible for these lesions. Our series is small and hence more extensive studies are called for.
| Summary|| |
Two cases of optic neuritis and one case of sixth nerve palsy immediately following an attack of viral conjunctivitis are reported.
| References|| |
Bharucha, E.P., and Mondkar, V.P., 1972, Lancet, 2 : 970.
Kono, R., Uchida, N., Sanagawa, A., Akao, Y., Kodama, H., Mukoyama, J., and Fujiwara, T., 1973, Lancet, 1 : 61.
Wahida, N.H., Irani, P.F., and Katrak, S.M.1973, Lancet, 1 : 350.