Eye infections can be serious
Viruses have led to almost any ocular infection from a simple conjunctivitis to vision threatening neuroretinitis. In all patients of conjunctivitis, viruses are responsible for 80% of cases. Measles (RNA) virus spread by aerosol leads to keratoconjunctivitis, One of the major causes of childhood blindness. Viral ocular involvement is seen in majority of viral infections, the only variation remains in intensity and symptomatology. Zoonotic influenza viruses have many a times infected the human race with corona virus pandemic adding to the previous list. Since COVs can cause ocular infection across different species, there is a definite possibility of COVs causing various ocular diseases. There are reports of itching, redness and foreign body sensation in eyes of COVID positive patients. Ocular symptoms commonly appear in patients with severe pneumonia.
Viral etiologies involving Epstein- Barr virus (EBV), Herpes simplex virus (HSV), Human immunodeficiency virus (HIV), mumps, Hepatitis B and C have already been implicated. Primary herpes simplex infection in neonates may present as ophthalmianeonatorum . Ninety percent of adults are seropositive for herpes simplex antibodies. There are reports of virus isolation from aqueous as well as Iris. Cytomegalovirus (CMV) Retinitis can lead to retinal detachment.
Influenza viruses are known for, annual epidemics and occasional pandemics leading worldwide high mortality and morbidity. Viral ocular involvement is seen in majority of viral infections, the only variation remains in intensity and symptomatology. The high infectivity of the virus illustrates the constant public health threat. The coronaviruses (COVs) are viruses that have been known to affect birds and mammals. COVs belong to subfamily coronavirinae, in the family coronaviridae of the order Nidovirales. As the present pandemic is continuing, our insight into the various aspects of ocular involvement with this viral disease will increase. There are reports of itching, redness and foreign body sensation in eyes of COVID positive patients. Ocular symptoms commonly appear in patients with severe pneumonia.
Presently the cases of mucormycosis are on the rise and it has already been declared as an epidemic. Mucormycosis is caused by a fungus called rhizopus. This fungus is widely distributed in soil, contaminated water, fruits and stale bread. The infection starts as an acute orbital cellulitis in a patient with headache, fever and lethargy. This is actually an opportunistic infection promoted by systemic acidosis and immune-suppression characterized by acute diarrhea, vomiting in children and diabetic ketosis in adults precipitate acidosis.
The mucor has an unexplained affinity for blood vessels causing thrombotic arteritis and phlebitis leading to widespread ischaemia and necrosis. The orbital finding includes an acute, fast growing unilateral proptosis in a chronically ill, lethargic patient with acidosis or immunosuppression. There is intense pain in the eye and periorbital region with swelling of lids and face. The infection can spread to sinuses which invariably may lead to intracranial extension.
A black eschar is common on all mucous membrane and skin. The condition is fatal within a week if not treated vigorously by combination of surgery and antifungal chemotherapy. In normal circumstances cases of mucormycosis are extremely rare affecting only immunecompromised patients having comorbid conditions, but present pandemic has seen significant increase in the number of cases particularly COVID19 affected patients, raising queries on the behavior of SARS-COV2.
A simple itching, burning and or redness to the eye should not be of much concern and should not cause any unnecessary panic as the season presently is of allergic conjunctivitis or spring catarrh because of the pollens and other allergens. Need of the hour is to take as much precautions as possible along with vaccination and do consult an ophthalmologist in case of any eye related ailment. As marie curie has rightly said ,”Nothing in life is to be feared , it is to be understood. Now is the time to understand more, so that we may fear less”.
The author is Assistant Professor, Department of Ophthalmology at GMC Anantnag.
