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Year : 1983  |  Volume : 31  |  Issue : 7  |  Page : 983-985

Optic neuritis: Post epidemic kerato conjunctivitis

Department of Ophthalmology, Sardar Patel Medical College, Bikaner, India

Correspondence Address:
G C Jain
Lecturer in Ophthalmology, P.B.M. Hospital, S.P. Medical College, Bikaner
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Source of Support: None, Conflict of Interest: None

PMID: 6544302

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How to cite this article:
Jain G C, Soni P C, Satsangi U K, Jain S. Optic neuritis: Post epidemic kerato conjunctivitis. Indian J Ophthalmol 1983;31, Suppl S1:983-5

How to cite this URL:
Jain G C, Soni P C, Satsangi U K, Jain S. Optic neuritis: Post epidemic kerato conjunctivitis. Indian J Ophthalmol [serial online] 1983 [cited 2021 Oct 21];31, Suppl S1:983-5. Available from: https://www.ijo.in/text.asp?1983/31/7/983/29723

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Table 2

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Table 1

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Table 1

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In India, outbreak of epidemic keratocon­junctivitis developed suddenly in many cities, towns and villages and most of the ophthal­mologists were treating cases without being aware of the true nature of the disease although they had witnessed it in the past also. It lasted from June 1981 to December, 1981 and subsided fairly rapidly during December, 1981.

This disease was seen in all age and sex groups patients with a few clinical alterations from the previous outbreaks. In addition, we have seen an interesting and important com­plication of optic neuritis developing in few cases of epidemic keratoconjunctivitis.

Optic neuritis as a complication or asso­ciation of epidemic keratoconjunctivitis has not been reported in the literature before.

  Materials and observations Top

Clinical characteristics of epidemic keratoconjunctivitis.

About six hundred seven cases of epidemic keratoconjunctivitis were registered for clini­cal evaluation at P.B.M. Hospital, S.P. Medi­cal College, Bikaner, India. This disease was seen in all the age and sex groups [Table - 1][Table - 2]. In most of the cases (90%), there was bilateral involvement. A basic difference seen in this epidemic as compared to previous one was the non-involvement of cornea, to start with haemorrhagic conjunctivitis was observed.

Depending upon its clinical presentation, the disease was divided into four stages:­ Stage I: No clinical manifestation of con­unctivities, but symptoms in the form of F.B. sensation, watering, burning sensation and mild oedema of lid.

Stage II Severe lid oedema. chemosis, dis­charge, severe follicles, sometimes pseudo­membrane. (a) Conjunctivitis alone. (b) Conjunctivitis with keratitis (S.P.K.). Stage III: Chemosis, discharge, follicles and lid oedema subsiding. (a) Presence of haemorrhagic areas in the conjunctiva. (b) Haemorrhagic areas with keratitis. (c) Super­ficial keratitis alone.

Stage IV. Conjunctivitis disappears, but S.P.K. remains with or without complications (secondary presentation). (a) Optic neuritis; (b) diplopia, (c) loss of accommodation; (d) systemic complication.

[Table - 3] shows the different mode of pre­sentation of these patients. 500 (82.4%) cases presented with primary signs and symptoms, while 107 cases (17.6%) came with secondary signs and symptoms of epidemic keratocon­iunctivitis.

Optic neuritis.

We have observed six cases of optic neuritis during and after epidemic keratocon­junctivitis. All these cases gave the similar his­tory of attack of epidemic keratoconjuncti­vitis (some of the patients were under the treatment) 7-15 days prior to sudden loss of vision. On examination, all these patients had superficial punctate keratitis and optic neuritis. In few patients. other signs of attack of epidemic keratoconjunctivitis were seen. Clinical details of these patients are given in [Table - 3].

Optic neuritis was seen in young indi­viduals from 18 to 49 years of age group.There were 4 males and 2 females. In all the cases, there was unilateral involvement. Three patients showed central scotoma, one hemianopic defect and in one case, field charting could not be done. All the inves­tigations were negative in these patients. After the diagnosis of optic neuritis all the patients were put on systemic corticosteroid (60mg/ day). There was remarkable improvement in all the patients (vision returned to 6/6) except one (vision improved to only 6/12).

Patients of secondary presentation did not require any specific treatment except patients having systemic complications. These patients also responded well with systemic cortisone therapy instituted by physican.

  Discussion Top

The disease epidemic keratoconjunctivitis is a well known and well defined clinical enti­ty. The incubation period (Seven to ten days). natural course, epidemiological behaviour of the disease, clinical characteristics, cytologic picture, lack of association with any special kind of bacteria and adenovirus as eitologic agent are well known.

Most of these recover completely after the attack, but various complications described with epidemic keratoconjunctivitis are cor­neal opacities, iritis, hyphaema, dac­ryoadenitis, orbital cellulitis, raised intraocular pressure and Stevens Johnson syndrome.

Optic neuritis as a complication or association of epidemic keratojunctivitis has never been reported in literature to the best of our knowledge.

Hemiparesis and paraplegia were seen in young individuals after an attack of keratoconjunctivitis. It was of sudden onset and they also responded well to systemic cor­tisone therapy.

Involvement of optic nerve and systemic complications does suggest that epidemic keratoconjunctivitis is not just a keratitis and conjunctivitis, but other more severe manifes­tations can occur.

  Summary Top

607 cases of epidemic kerato conjunctivitis were reviewed. Their primary presentation was as conjunctivitis, subconjunctival haemorrhages or superficial punctate keratitis, while secondary presentation included headache, eyeache, heavyness of eyes, defective vision, defective near work, diplopia, hemiparesis and paraplegia. Optic neuritis was recorded in six patients. All these patients responded well to systemic cortisone therapy. This complication following epidemic. keratoconjunctivitis has not been reported before.


  [Table - 1], [Table - 2], [Table - 3]


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