Eales Disease: Causes, Symptoms, Diagnosis, and Treatment

The disease of Eales is an idiopathic vasculopathy involving the retinal peripheral. This is an unusual ophthalmic disease with three levels of vasculitis, Occlusion and RN. Henry Eales identified it in 1880 for the first time in stable young men who had an irregular retinal vein and recurrent vitreal hemorrhages.

Eales Disease occurs in the retinal area as inflammation and white haze. The disease is most common in young males and usually affects both eyes. In this condition, the clear jelly that fills the eyeball behind the lens of the eye seeps out, and hence vision is suddenly blurred.

Epidemiology

The prevalence is unknown. Though the condition has been recorded worldwide it is most widely found in the Indian subcontinent where the approximate annual occurrence is 1/135-1/200 ophthalmic patients. Of late, the disease incidence appears to be reducing. The age of onset is 20 to 30 years.

Signs and Symptoms of Eales Disease

Bleeding of the sclera, Credits: canva

The narrow external veins of the retina undergo sheathing at the initiation of the disease.

The inflammation in the eye spreads farther behind the lens as the condition progresses.

Retinopathy and extensive retina bleeding are the most advanced phases of Eales disease. The retina gets detached in rare situations. The iris can also be seen with reddish discoloration, vision loss and optical disk effect.

Causes

free radicals, Credits: canva

The exact causes of the disease are not determined. Several experiments have predicted the function of human leukocyte antigen, the retinal S-Antigen autoimmunity, the mycobacterium tuberculosis genome, free radical disruption and the pathogenic effect in Eales disease.

There have been reports of an improvement in peptide growth factors such as a growth factor in platelets, insulin-like growth factors, a growth factor epidermal, alpha and beta converting growth factors, a vascular endothelial growth factor, urokinase, enzymes of metalloprotease, and an 88kDa protein.

Diagnostic Methods

An eye examination, Credits: canva

Early changes, such as periphlebitis, vascular sheathing, or peripheral nonperfusion, are recognized by fluorescein angiography fundus (FFA). The peripheral lesions in the retina are detected via widefield angiography. To rule out the associated retinal detachment, ultrasonography is needed. Ocular coherence tomography (OCT) is used for high-resolution imaging of the retina.

Treatment of Eales Disease

Anti-oxidants, Credits: canva

Symptomatic and supportive therapy is provided for Eales disease. Eales disease management depends on the level of the disease.

Periodic assessment, steroids, and antitubercular drugs are used in the management of the disease. Antioxidant vitamins A, C, and E have been recommended as potential treatment for vitreous samples in patients with the disease of Eales. Intravitreal bevacizumab injections have been confirmed to lead to regression of the Eales-related neovascularization.

Laser panretinal photocoagulation is used to reduce blood deficiency caused by blood vessel constraint and to decrease abnormal blood vessel tissue formation. In non-resolving vitreous bleeding (usually > 3 months), vitreous surgery is suggested. The definitive treatment for Eales Disease is being investigated currently intravitreal anti-VEGF therapy.

Prognosis

ED blindness is uncommon. No documented disease-related mortality is found.