Like the measles, love is most dangerous when it comes late in life — Lord Byron
The re-emergence of measles on American shores provides the opportunity for ophthalmologists to acquaint (or reacquaint) themselves with the ophthalmic manifestations of this disease. It is good that we have pediatricians and primary-care physicians who are still practicing into their 70s, as they will be the most prepared to recognize these cases. But thanks in large part to widespread immunization, most physicians in practice today were too young to contract measles themselves in childhood and have never seen a patient present with the measles.
According to news reports, the recent spike in measles cases (about 800 and rising as of the time I write this, with close to 10 cases in my state of Maryland) is largely the consequence of unvaccinated Americans traveling to other countries and returning to transmit the virus to others while they are asymptomatic or before the disease is recognized.
A literature review reveals that the ophthalmic manifestations of measles are limited – in the sense that they are limited to every part of the visual pathway from the ocular surface all the way back to the cortex. A self-limited (in healthy children) conjunctivitis and keratitis may present in the front of the eye.
Deeper in, uveitis, retinitis, choroiditis, and optic neuritis may all be part of the disease, and result in permanent vision loss. The virus can gain access to the central nervous system and cause encephalitis. A particularly tragic manifestation of the disease is subacute sclerosing panencephalitis (SSPE). This disease occurs after a bout of measles followed by a latency period of six to eight years.
Peter J. McDonnell, MD
E: [email protected]
Dr. McDonnell is the director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.
1. Semba RD, Bloem MW. Measles blindness. Surv Ophthalmol 2003;12:5.