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Measles has long been one of the leading causes of childhood blindness worldwide, but with the recent U.S. outbreak-due to a decrease in vaccination compliance for the disease-many parents nationwide are growing concerned. While there are no specific anti-viral treatments for the disease, there are several crucial ways ophthalmologists can stop the outbreak in its tracks, according to David Hunter, MD, PhD.
Measles has long been one of the leading causes of childhood blindness worldwide, but with the recent U.S. outbreak-due to a decrease in vaccination compliance for the virus-many parents nationwide are growingly concerned. While there are no specific anti-viral treatments for the disease, there are several crucial ways ophthalmologists can stop the outbreak in its tracks, according to David Hunter, MD, PhD.
“With measles essentially eradicated in the United States, most practicing physicians today-including ophthalmologists-have not treated patients with ocular complications of the disease,” said Dr. Hunter, an American Academy of Ophthalmology spokesperson and professor of pediatric ophthalmology at Harvard University, Cambridge, MA.
According to the Academy, there are six ways the measles virus can harm eyes and affect vision:
1. Conjunctivitis: “Redness and watery eyes from conjunctivitis occur in nearly all measles patients,” the Academy said in a prepared statement. “This type of pink eye usually develops early on in the disease and is a hallmark symptom along with fever, cough and a runny nose, often occurring before the telltale rash.”
3. Corneal scarring
4. Retinopathy: “While rare, there are documented cases where the measles virus destroys the retina,” the Academy said.
5. Optic neuritis: “This complication is relatively rare, but can occur in measles patients who also develop encephalitis,” the Academy explained.
6. Blindness: “Measles is a leading cause of childhood blindness in developing countries where immunization programs for this disease are less established or often interrupted by conflict,” the Academy said.
In addition to educating patients on these complications, Dr. Hunter said there are several ways ophthalmologists can prevent measles from harming or destroying vision.
1. Notice the early signs: “The triad of presenting symptoms in measles is cough, coryza, and conjunctivitis, thus, a patient with conjunctivitis as an early manifestation might present first to the ophthalmologist,” he explained. “These features may precede the classic cutaneous manifestations, but an astute clinician could make an early diagnosis by asking whether a child with this clinical picture has received a measles vaccination.
“This is critical because early identification and isolation of affected patients is key to stopping spread of the disease,” he added.
2. Know the virus’ risks: “Once the cutaneous manifestations ensue, patients may also develop small, red-rimmed, bluish-white dots on the conjunctiva (Kopik’s and Hirschberg’s spots), as well as keratitis,” Dr. Hunter said. “These findings are almost always self-limited. However, children in developing nations with vitamin-A deficiency may suffer permanent vision loss from measles keratitis.
“Regardless of their nutritional state, rare patients may develop rubeola retinitis, with attenuated retinal vessels, optic disc swelling, small hemorrhages, and stellate macular lesions,” he continued. “This, too, is usually self-limited. More advanced retinal involvement-which is extremely rare but could lead to permanent vision loss-includes macular edema, choroiditis, whitish retinal infiltrates, serous macular detachments, areas of retinal depigmentation, and optic neuritis.”
3. Reassure the family: “An ophthalmologist caring for a child with measles should reassure parents that the ocular manifestations are usually limited to conjunctivitis, and that most ocular manifestations are self-limited,” Dr. Hunter said. “When providing information to those who have chosen not to vaccinate their children, it may be helpful to list the litany of severe ocular complications above, including the potential for permanent vision loss, to help motivate parents to change their behavior and have their children vaccinated.”
Regardless, Ernest W. Kornmehl, MD-an Ophthalmology Times Editorial Advisory Board Member-stressed the importance of prevention to eliminate the virus’ life-altering effects on vision.
“Measles is 100% preventable with proper vaccination,” said Dr. Kornmehl, medical director at Kornmehl Laser Eye Associates, Wellesley and Brookline, MA, and clinical instructor, Harvard Medical School and associate clinical professor in ophthalmology, Tufts School of Medicine, Boston. “The loss of vision caused by measles can be life altering.
“The guilt a parent would feel who voluntarily did not vaccinate their child who suffered vision loss would be overwhelming,” he added.