Effects of West Nile virus on vision???

[rkl_OD2be]

On Sunday mornings, I play bass guitar in the "praise band" at our Church. Yesterday morning, our saxophone player informs us that this will probably be the last time he can play with us for a while...

This young person (16 or 17 years old) missed almost two months of school (and time playing with our band) last fall. About the time school started, he became sick. The only symptoms I know were persistant headaches. From what I gathered, it sounded like the doctors didn't know what was wrong. Around the first week of November, we learned it was West Nile Virus.

After the diagnosis was made, and appropriate treatment (I don't know the details) started, he seemed to be getting better (dating from about Thanksgiving to present).

He told me at church yesterday that he is losing his vision. At first, it was blind spots, but it progressed to total blindness in the right eye (OD?). He said he researched on the internet that in rare instances, west nile virus caused temporary blindness, lasting 3 or 4 weeks, then normal vision returns.

In any event, his mother was taking him to the ER after services yesterday, so he is seeking appropriate professional help. As someone who will be starting optometry school next fall, I'm curious as to the prognosis for recovery, as well as the related cause(s)/mechanism(s). Have any currently practicing OD's out there have seen such cases. Should I have told him to consult his OD, or was he correct in going to the hospital ER?

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[xmattODx]

Have any currently practicing OD's out there have seen such cases. Should I have told him to consult his OD, or was he correct in going to the hospital ER?

A quick search of medline using the words West Nile Virus and Blindness netted four articles. The most recent stating:

Twenty-three patients (79.3%) were found to have posterior segment involvement. Other less common findings included anterior uveitis (4 patients [13.8%]), subconjunctival hemorrhage (2 patients [6.9%]), sixth nerve palsy (1 patient [3.4%]), and nystagmus (1 patient [3.4%]). Six patients (20.7%) had no ocular findings related to WNV infection. Fifteen of 23 affected subjects (65.2%) had no ocular symptoms, and 8 (34.8%) recently experienced ocular symptoms, including floaters (8 patients [34.8%]), blurred vision (6 patients [26.1%]), redness (6 patients [26.1%]), visual field defect (1 patient [4.3%]), and diplopia (1 patient [4.3%]).

The youngest patient in the above study was 22, however.

In a series of case reports in children ocular manifestations are noted:

CNS involvement can include...optic neuritis

I would send to an infectious disease expert who could then refer to an appropriate OMD.

 

[anchan]

one of my professors did a study on this, i haven't read the article myself but if you want some more information the link is here

http://linkinghub.elsevier.com/retrieve/pii/S1529-1839(05)00133-8

if that doesn't work, just use pubmed and type in
author: koevary, SB

his article on west nile shoudl come up

 

[ddown]

20% will present with mild symptoms lasting 3-6 days which can include ocular manifestations such as conjunctivitis, photophobia, eye pain, floaters, uveitis, and vitritis.

1/150 will have a severe infection (encephalitis, meningitis) which can last up to several weeks and may have permanent neurological effects. Ocular sequelae include optic neuritis and cranial nerve abnormalities.