EALES DISEASE

EALES DISEASE

•  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

Don’t Forget to Solve all the previous Year Question asked on EALES DISEASE
Click Here to Start Quiz