The most recent Ebola outbreak has infected over 26,300 patients, but also resulted in the highest number of survivors in history. Uveitis has been described during the convalescent period, but Varkey and colleagues report, for the first time, finding viable Ebola virus in the aqueous fluid of a 43-year-old male doctor nine weeks after clearance of viraemia. At this point a patient would ordinarily no longer be considered infectious. The patient had been treated with an experimental small RNA interfering agent, as well as convalescent plasma (blood product from an Ebola survivor) and supportive care for multi-organ failure including ventilation and haemodialysis. After a protracted ICU stay his blood and urine tested negative for virus and he was discharged home. Interestingly, as his semen continued to test positive for virus, he was advised to abstain from sex or to use condoms for at least three months. This is noteworthy as the gonads are an immune-privileged site alongside the eye, brain and articular cartilage. After discharge, the patient, who had no previous ocular history, began to complain of symptoms of uveitis and a foreign body sensation. Repeat examinations revealed stable bilateral chorioretinitis but a marked anterior chamber reaction and elevated IOP of 44mmHg then developed. Topical prednisolone drops resulted in a rapid deterioration and an aqueous tap revealed viable Ebola virus. Reassuringly, a conjunctival swab and tear film fluid were negative. The patient continued to deteriorate with marked scleritis and uveitis. The marked vitritis was treated with periocular triamcinolone, oral faviparivir and oral steroids. After six weeks the patient had recovered. The authors concluded that this panuveitis was due to the direct cytopathic effect associated with viral replication as this has previously been seen with Marburg virus. This case demonstrates that the eye can act as a reservoir of infection for Ebola which has significant implications for all clinicians. Ophthalmologists should take extra precaution during ocular examinations and procedures in patients suspected of having, or who have recovered from, Ebola virus. 

Persistence of Ebola virus in ocular fluid during convalescence.
Varkey JB, Shantha JG, Crozier I, et al.
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Jonathan CP Roos

Harvard, Cambridge & Moorfields-trained Consultant Oculoplastic Surgeon and academic based in London at Publishes in the world’s leading medical journals and lectures internationally on aesthetics, eyelid diseases and thyroid eyes.

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