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Spots before the eyes

By Sasha L Radford, OD

What’s the first thing that comes to your mind when a child has red, watery eyes? “Pink eye” is the dreaded verdict, as it can empty an entire classroom in a matter of days. Bacterial conjunctivitis is usually the culprit, especially in preschool or grade school-aged children.

There are many other causes of red, runny eyes, however, including allergic conjunctivitis and viral conjunctivitis. While it’s fairly straightforward to alleviate the symptoms of ocular allergies, viral forms of eye infections are not so easily treated. Typically a virus just has to run its course which can mean symptoms lasting up to two or three weeks.

A virus that has gained a lot of press recently is responsible for a form of conjunctivitis that precedes a more serious illness. The measles virus causes red, watery eyes that cannot be eliminated with eye drops.

Measles begins much like a cold or sinus infection – runny nose, fever, a cough, and red eyes. The rash develops some four days later. However, unlike the common cold, the ocular manifestations are more severe – the eyes are sore and often light sensitive. There will be swelling and redness of the eyelids and a watery discharge. In many cases keratitis occurs – this is an inflammation of the cornea, the clear tissue which covers the iris – causing light sensitivity, pain, and blurred vision. These symptoms can persist up to five to seven days after the rash appears. Rarely, the measles virus can cause vision loss by damaging the retina and optic nerve.

While the recent outbreak of measles has not reached Illinois, some children here may nevertheless be at risk due to widespread travel and the highly infectious nature of the virus. According to the National Immunization Survey conducted by the Centers for Disease Control and Prevention, the rate of vaccination for MMR (mumps, measles, rubella) in the state of Illinois is around 90%. That leaves 10% of Illinois children unprotected and at risk for contracting the virus.

There are two problematic characteristics of the measles virus that make an outbreak likely to occur. First is its highly contagious nature – the virus is airborne and can survive up to two hours on inanimate surfaces – 90% of those who have no immunity will contract the disease upon exposure. Second, the measles virus can be spread by someone two to four days before any symptoms develop, so he or she can be transmitting it unknowingly.

Besides having a fever, full body rash, and being generally miserable for several days, contracting measles carries significant risks and not everyone has a favorable outcome. One in a thousand measles cases develop encephalitis, an inflammation of the brain that results in permanent brain damage. One to two in a thousand children with measles die from either respiratory or neurological complications. Even in cases that resolve, there is a risk of developing a serious neurological condition called subacute sclerosing panencephalitis 7 to 10 years later which is fatal if not identified and treated early.

Anyone who has not had the MMR vaccine is at risk, especially children under 5 years of age, pregnant women, and anyone with a compromised immune system. Those who cannot receive the vaccination include those allergic to a component of the vaccination itself and those with poor immune systems, such as children being treated for cancer or those who have received an organ transplant. The unvaccinated rely on the concept of “herd immunity” – when the majority of a population is vaccinated, the decreased incidence of the virus protects those that legitimately cannot be vaccinated for medical reasons.

The recent trend of parents refusing to have their healthy children vaccinated is the reason recent outbreaks of measles and other childhood diseases have occurred. They risk the health of not only their own children, but also those who have medical conditions which preclude them from receiving the vaccination.

If you or someone you know has a child who is not immune to measles for whatever reason, be aware of the early signs and symptoms of the disease and act quickly to seek treatment and prevent its further spread.