Ocular complications in Ebola virus disease survivors: the importance of continuing care in West Africa

ABSTRACT

Introduction: The largest Ebola virus (EBOV) outbreak occurred from 2013 to 2016 in West Africa and consequently resulted in the largest cohort of Ebola virus disease (EVD) survivors to date. Ocular disease is among the most common sequelae reported in EVD survivors. This review discusses the prevalence, manifestations, pathogenesis, diagnosis, and management of EVD-related ocular disease.

Areas covered: An extensive review of the literature was performed to detail the prevalence and manifestations of EVD-related ocular disease. We also review current eye screening and treatment strategies and our current understanding and approach to invasive ophthalmic procedures including surgery.

Expert opinion: The ocular sequelae of EVD can lead to vision impairment or blindness, if untreated. Keys to the prevention of such an outcome include timely evaluation and access to appropriate ophthalmic care. The persistence of EBOV in the eye and other immune-privileged sites is the subject of ongoing investigation, but should not be a barrier to care if appropriate screening and biosafety measures are taken. Improved understanding of the pathogenesis of this condition and ongoing clinical care is needed for EVD survivors at-risk for ocular complications.

KEYWORDS:

• Ebola
• Ebola virus
• Ebola virus disease
• Ebola sequalae
• uveitis

Article highlights

• EVD has a high prevalence of ocular involvement, particularly uveitis; continued study is needed to determine pathogenesis and natural history.

• Topical and oral steroids are effective strategies for intraocular inflammation, but more research is needed to establish definitive guidelines and treatment strategies, particularly for recurrent cases.

• The EVICT study has resulted in a model for safe and feasible cataract surgery resulting in vision restoration for a cohort of EVD survivors.

• Continued resources and funding are needed to address ophthalmology clinical care and education gaps, medication and equipment limitations, and other health-care disparities that present barriers to evaluation and treatment of eye care in EVD and other emerging infectious diseases.

Acknowledgments

The authors gratefully acknowledge Ebola virus disease survivors and their families, as well as their many partners in Sierra Leone and Liberia with whom they have worked. Specifically, the authors thank the Lowell and Ruth Gess/Kissy United Methodist Church Eye Hospital, Dr. Lowell Gess and the Gess family, Mr. Roger and Mrs. Melanie Reiners, Mr. Ibrahim Conteh, Central Global Vision Fund and Christian Blind Mission International. We also thank the Sierra Leone Association of Ebola Survivors, Bishop John Yambasu, Mr. Rahm and Mrs. Radha Sitaraman, Partners in Health, Santen, Inc, Alcon Research Institute, Bayer Global Ophthalmology Awards Program, the Marcus Foundation, Emory University School of Medicine, Emory Global Health Institute, Emory Retina and Uveitis Services, and the Emory Eye Center leadership for their support.

Declaration of interest

S Yeh reports being a consultant for Santen, Inc. and Clearside Biomedical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This project was supported by unrestricted departmental grant from Research to Prevent Blindness, Inc. (New York, NY), NIH/NEI core grant P30-EY06360 (Department of Ophthalmology, Emory University School of Medicine), Building Interdisciplinary Careers in Women’s Health of the National Institutes of Health K12HD085850 (J Shantha), an Alcon Research Institute Young Investigator Grant (S Yeh), Bayer Global Ophthalmology Awards Program (J Shantha), Marcus Foundation Combating Childhood Illness Seed Grant to Emory Global Health Institute (S Yeh), Emory University Research Committee Grant (S Yeh) and an unrestricted grant from Santen, Inc. (S Yeh, J Shantha) and the Rahm Sitaraman family.