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Ophthalmology – Eales Disease
Eales disease is an idiopathic obliterative retinal vasculopathy that primarily affects young adults, classically presenting with a triad of retinal phlebitis, peripheral retinal nonperfusion, and recurrent vitreous hemorrhage. It is considered a diagnosis of exclusion, meaning other causes of retinal vasculitis must be ruled out before confirming the condition.
The disease is most commonly reported in regions such as India and the Middle East, typically affecting individuals between 20 and 30 years of age. Earlier studies suggested a male predominance, but more recent data indicate a more equal gender distribution. A possible association with hypersensitivity to tuberculin protein has been proposed, and tubercle bacilli have occasionally been identified in pathological specimens, although the exact cause remains unclear.
Pathophysiologically, Eales disease involves a nonspecific inflammatory occlusive vasculitis, primarily affecting retinal veins. This leads to vascular inflammation (phlebitis), followed by capillary closure and ischemia, which in turn stimulates retinal neovascularization. These fragile new vessels are prone to bleeding, resulting in recurrent vitreous hemorrhage, a hallmark complication.
Patients commonly present with decreased vision, floaters, or “cobweb-like” visual disturbances, often due to vitreous hemorrhage. On examination, findings include retinal vascular sheathing, hemorrhages, and exudates along affected vessels. More than half of patients have bilateral involvement. Additional findings may include vitreous cells, cystoid macular edema, and neovascularization of the retina or optic disc, which can progress to neovascular glaucoma if untreated.
Diagnosis relies heavily on fluorescein angiography, which helps identify areas of retinal nonperfusion, vascular leakage, and neovascularization. Optical coherence tomography (OCT) may detect associated macular edema or epiretinal membranes. Since Eales disease is a diagnosis of exclusion, investigations are necessary to rule out other causes such as diabetes, sickle cell disease, retinal vein occlusion, inflammatory or infectious vasculitis, and systemic autoimmune conditions.
Management focuses on controlling complications. Panretinal photocoagulation (laser therapy) is essential in cases with retinal ischemia and neovascularization to prevent further hemorrhage and tractional complications. Corticosteroids, either systemic or intravitreal, may help reduce inflammation and vascular leakage. Anti-VEGF agents (such as bevacizumab) are sometimes used to induce regression of neovascularization. In advanced cases with persistent vitreous hemorrhage or tractional retinal detachment, vitrectomy surgery may be required.
Patients require regular follow-up every 3 to 12 months, depending on disease severity, to monitor for progression and complications. Education is important—patients should be aware of symptoms such as sudden floaters or vision loss, which may indicate vitreous hemorrhage.
The prognosis is generally favorable with appropriate management, with many patients maintaining visual acuity of 20/40 or better. However, complications such as recurrent vitreous hemorrhage, retinal detachment, and neovascular glaucoma can significantly impact vision if not treated promptly.
Eales disease is an idiopathic obliterative retinal vasculopathy that primarily affects young adults, classically presenting with a triad of retinal phlebitis, peripheral retinal nonperfusion, and recurrent vitreous hemorrhage. It is considered a diagnosis of exclusion, meaning other causes of retinal vasculitis must be ruled out before confirming the condition.
The disease is most commonly reported in regions such as India and the Middle East, typically affecting individuals between 20 and 30 years of age. Earlier studies suggested a male predominance, but more recent data indicate a more equal gender distribution. A possible association with hypersensitivity to tuberculin protein has been proposed, and tubercle bacilli have occasionally been identified in pathological specimens, although the exact cause remains unclear.
Pathophysiologically, Eales disease involves a nonspecific inflammatory occlusive vasculitis, primarily affecting retinal veins. This leads to vascular inflammation (phlebitis), followed by capillary closure and ischemia, which in turn stimulates retinal neovascularization. These fragile new vessels are prone to bleeding, resulting in recurrent vitreous hemorrhage, a hallmark complication.
Patients commonly present with decreased vision, floaters, or “cobweb-like” visual disturbances, often due to vitreous hemorrhage. On examination, findings include retinal vascular sheathing, hemorrhages, and exudates along affected vessels. More than half of patients have bilateral involvement. Additional findings may include vitreous cells, cystoid macular edema, and neovascularization of the retina or optic disc, which can progress to neovascular glaucoma if untreated.
Diagnosis relies heavily on fluorescein angiography, which helps identify areas of retinal nonperfusion, vascular leakage, and neovascularization. Optical coherence tomography (OCT) may detect associated macular edema or epiretinal membranes. Since Eales disease is a diagnosis of exclusion, investigations are necessary to rule out other causes such as diabetes, sickle cell disease, retinal vein occlusion, inflammatory or infectious vasculitis, and systemic autoimmune conditions.
Management focuses on controlling complications. Panretinal photocoagulation (laser therapy) is essential in cases with retinal ischemia and neovascularization to prevent further hemorrhage and tractional complications. Corticosteroids, either systemic or intravitreal, may help reduce inflammation and vascular leakage. Anti-VEGF agents (such as bevacizumab) are sometimes used to induce regression of neovascularization. In advanced cases with persistent vitreous hemorrhage or tractional retinal detachment, vitrectomy surgery may be required.
Patients require regular follow-up every 3 to 12 months, depending on disease severity, to monitor for progression and complications. Education is important—patients should be aware of symptoms such as sudden floaters or vision loss, which may indicate vitreous hemorrhage.
The prognosis is generally favorable with appropriate management, with many patients maintaining visual acuity of 20/40 or better. However, complications such as recurrent vitreous hemorrhage, retinal detachment, and neovascular glaucoma can significantly impact vision if not treated promptly.
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