Eales disease

DEFINITION:
  • Idiopathic obliterative perivasculitis
  • Unknown etiology
  • Healthy young adult (97.6%) of Indian subcontinent
  • Extensive retinal nonperfusion
  • Perivascular sheathing
  • Neovascularization of disc and retina
  • Recurrent vitreous hemorrage
AETIOLOGY:
  • Idiopathic
  • Nontuberculous mycobacteria M. fortuitum and M. chelonae isolated from classical eales’ disease pt’s aqueous and ERM 
  • Higher phenotype frequency of HLA B5, DR1 and DR 4
  • Probably this HLA predisposition could be responsible for the presence of sequestered mycobacterium
CLASSIFICATION:
  • Periphlebitis of unknown aetiology
  • Vasculitis with tuberculous chorio retinitis
CLINICAL FINDINGS:
  • Avascular areas in the retina periphery
  • Microaneurysms, dilatation of capillary channels, tortuosity of neighboring vessels
  • Spontaneous chorioretinal scars.
  • It is a diagnosis of exclusion, as many other retinal disorders can mimic Eales disease, especially conditions of retinal inflammation & detachment or neovascularization Both soft and hard exudates are seen in Eale's disease
Physical Findings:
  • The physical findings mostly involve the retina and vitreous.
  • Vascular sheathing with adjacent nerve fiber layer hemorrhages is seen in most patients.
  • The sheathing can manifest as thin white lines, limiting the blood column on both sides of the sheathed vessel to heavy exudative sheathing that can cause vascular occlusion. Although believed to affect primarily the retinal veins, others have reported the same prevalence of both venules and arterioles.
  • The anterior chamber may exhibit cell and flare with keratic precipitates. 
  • Sudden, painless loss of vision & floaters in front of the eye
  • Vitreous debris and cells often are seen, even in the absence of vitreous hemorrhage. 
  • Macular edema can occur in eyes with vascular sheathing, and it often is cystoid in nature.
  • Epiretinal membranes with or without macular edema can compromise visual acuity. 
  • The etiology of the macular edema is thought to be associated with low-grade inflammation
  • Peripheral nonperfusion is a typical feature of Eales disease 
  • Parachute lesions are seen in Eale's disease
COMPLICATIONS:
  • Branch retinal vein occlusion (BRVO) can be seen in patients with Eales disease and may be limited to one area or may be multifocal
  • Neovascularization of the disc (NVD) or neovascularization elsewhere (NVE) in the retina is observed in up to 80% of patients with Eales disease. 
  • Cystoid macular edema can occur in patients with Eales disease due to increased capillary permeability.
  • A posterior vitreous separation has been reported in 27% of patients with Eales disease 
  • Vestibuloauditory dysfunction Myelopathy, ischemic stroke, hemiplegia, and multifocal white matter abnormalities have been reported. 
TREATMENT:
  • Treatments include thyroid extract, osteogenic hormones, androgenic hormones, and systemic steroids. 
  • The antioxidant vitamins A, C, and E have been suggested recently as a possible therapy because antioxidizing enzymes are deficient in the vitreous samples of patients with Eales disease
  • Argon laser is used in Eales' disease
Exam Question
  • Eales disease is Recurrent vitreous hemorrage
  • Panretinal photocoagulation is done in Eales disease
  • Eales disease is characterized by Recurrent retinal haemorrhage, Recurrent vitreous haemorrhage & Neovascularization
  • A 27-yr male presents with a sudden, painless loss of vision. His ocular and systemic history is unremarkable. The most likely diagnosis is Eales’ disease
  • A patient with tuberculosis presents with complaints of sudden appearence of floaters in front of the eye. A diagnosis of Eales disease is made.
  • Retinal detachment seen in Eale's disease
  • In a young patient presenting with recurrent vitreous hemorrhage, diagnosis is Eale's disease.
  • A 25 year old male presents withpainless sudden loss of vision, ocular and systemic examination is not contributory is diagnosed with Eale's disease.
  • Eales disease is Recurrent periphelbitis retina.
  • Eale's disease is Vitreous hemorrhage
  • Eales' disease is best treated with Steroids
  • Argon laser is used in Eales' disease
  • Both soft and hard exudates are seen in Eale's disease
  • Parachute lesions are seen in Eale's disease
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