Dr Ian Crozier contracted Ebola virus disease (EVD) in September 2014, while working with the World Health Organization (WHO) to treat Ebola patients in Sierra Leone. The 44-year-old was returned to the US for treatment at the Emory University Hospital in Atlanta where, after multiple organ failure, the virus left him fighting for his life.
However, just weeks after he recovered and was given the all clear by doctors, he returned to the hospital with chronic ocular symptoms and failing eyesight.
Speaking to the New York Times, Dr Crozier reported that at one point he lost his sight in the left eye and intraocular pressure dropped to the point where the eye started to become flaccid. “The eye felt dead to me,” he told the newspaper. The full clinical findings are reported in a case report, which is published in the New England Journal of Medicine (NEJM) this month (May 7).
The case report details how the health worker presented with complaints of burning sensations in his eyes, photophobia and feelings of the presence of foreign bodies. Accommodative changes meant a change in spectacle prescription was needed. Ten days after symptoms, Dr Crozier noticed that the colour of his left eye had changed from blue to green.
Due to the inflammation and scarring of the choiroid, a diagnosis of posterior uveitis was given and steroids administered. However, the next month, Dr Crozier returned with acute redness, blurred vision, pain and highly elevated intraocular pressure in his left eye. After treatment with steroids failed to tackle the inflammation and increasing pressure, ophthalmologists pierced the eye to extract a small amount of aqueous humor for analysis – fearing a compromised immune system had left Crozier open to infection from other bugs. The doctors were shocked at the results: the eye was ‘teeming with Ebola.’
The immune privileged status of the eye meant that the virus was able to replicate unchecked in the eye, without interference from the immune system. It was known that viruses could persist in immune privileged regions, such as the testes, being present in semen for months after the immune system clears it from the rest of the body.
Over the following few months, Dr Crozier received a course of antivirals and steroid treatment to tackle the inflammation. He regained his vision and the eye returned to its original blue colour. Follow up ophthalmic examinations are reported to be ongoing.
While experimental treatments are being developed and tested, there are currently no effective licensed treatments or vaccines for Ebola. Dr Crozier’s medical team believe that the course of treatment allowed his immune system to battle the virus.
Since the current outbreak in West Africa began in 2014, more than 26,500 cases of Ebola virus disease (EVD) have been reported, resulting in more than 11,000 deaths, mainly in across Guinea, Liberia, and Sierra Leone. While the WHO and aid organisation Medicins Sans Frontiers (MSF) has reported a declining trend in the number of new cases, the outbreak will not be officially over until there are no new cases reported.
Eye symptoms have emerged as a common symptom among Ebola survivors, in a suite of symptoms which have been termed post-Ebola syndrome. In November 2014, following an Ebola survivors conference in the WHO warned of lasting eye damage to patients.
Image credit: A Dowsett, Health Protection Agency/Science PhotoLibrary