Eales’ Disease: When the Rare Sounds Frequent

Abstract

Eales’ disease is a peripheral occlusive retinal phlebitis, with an unclear pathogenesis. The classic association with hypersensitivity to Mycobacterium tuberculosis protein infers that immunologic disturbance may be involved. Here, we described three cases of Eales’ disease. All patients are Caucasian men aged 27-58 years and presented with vitreous hemorrhage and/or peripheral venous vasculitis. Tuberculin skin sensitive test (Mantoux screening test) and interferon-gamma release assay (IGRA) were positive in all patients. Therapeutic approach included antituberculosis therapy and systemic steroids, associated or not to immunosuppressive therapy, and retinal scatter photocoagulation in all cases. Antivascular endothelial grow factor (VEGF) intravitreal injections were also required in two cases. Since various retinal diseases can resemble this presentation, Eales’ disease is considered a diagnosis of exclusion. Early diagnosis and appropriate therapeutic approach are both essential to accomplish disease control and reduce ophthalmologic complications.

A Multidisciplinary Approach to the Management of Eales Disease: A Case Report and Review of the Literature

“…A fundus examination revealed similar findings in our patient along with a vitreal hemorrhage and thick epimacular membrane. Lopes et al reported similar findings in a series of three Eales disease cases [ 11 ].…”

“…The disease is most common in young male adults and it is usually bilateral. Asymmetrical involvement of the eyes has been reported; the disease can unilaterally manifest in the early stages, but usually both eyes are involved as the disease progresses [ 1 , 11 , 17 ]. Nicolcescu et al reported the case of a 48-year-old woman with unilateral Eales disease.…”

“…Azathioprine may be used as a steroid-sparing agent in the case of significant side effects due to systemic corticosteroids, or in patients who do not respond to corticotherapy [ 11 , 14 ]. Saxena et al evaluated the efficacy of combined oral corticosteroids and a pulsed low-dose oral methotrexate therapy in Eales disease.…”

“…Eales disease carries a good visual prognosis with an early diagnosis, proper treatment and regular follow-ups. Vision loss is most commonly caused by recurrent vitreous hemorrhages, which are usually transitory [ 11 ]. Severe vision loss is usually caused by retinal detachment.…”

Immune Privilege Furnishes a Niche for Latent Infection

“…All of the above classes of microbes have been associated with intermediate uveitis (90,(128)(129)(130)(131)(132). Latent tuberculosis has been implicated in peripheral occlusive retinal vasculitis (previously known as Eales' disease) (133)(134)(135), while latent EBV infection is a strong candidate for the same pathology in MS (84,136). Pars planitis with or without snowbanking has been linked to parasitic infections such as toxocariasis (137) while vitritis has long been associated with low level infections with mycoplasma and other cell wall deficient bacteria (138,139).…”