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Eales' disease
Dr Chinmayi Vyas
M.S.
Dr Jyotirmay Biswas
M.S., FAMS, FIC Path,FAICO
Director of Uveitis and Ophthalmic pathology
Sankara Nethralaya, Chennai,India
Ocular History
 30 year old lady
 February 2012 complaints of left eye blurred vision
with floaters.
 No h/o similar problems
 Systemic history : unremarkable
February 2012 : First Presentation
Right eye
Left eye
BCVA
6/6; N6
3/60, N36
IOP
35
28
Anterior segment
Normal
Vitreous cells ++
Fundus findings
Normal
Occlusive vasculitis
with active retinitis
in superiotemporal
quadrant
February 2012 : First Presentation
 ESR:12 mm
 Mantoux Test : positive
 Serum Angiotensin converting enzyme: 8.4 U/L
 QuantiFeron TB gold test : positive
 High resolution computed tomography scan chest :
non specific lesion
February 2012
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Eale’s disease v/s presumed tuberculous vasculitis
Started on Oral prednisolone 1 mg/kg (60 mg/day)
Reviewed with chest physician: started on 2 drug anti
TB Rx for 9 months.
High Intra ocular pressure on first visit: steroid
responder ?? Started on anti glaucoma Rx
Feb 2012 – June 2012
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Improvement in vision
Right eye 6/6 , N6 ; Left eye 6/9, N6
Activity reduced as compared to first visit.
Oral steroid tapered, anti glaucoma treatment
continued
June 2012
 complains of reduced vision in Left eye
 Patient was on prednisolone 10 mg/day
Right eye
Left eye
BCVA
6/6; N6
3/60, N36
IOP
10
12
Anterior segment
quite
Vitreous cells ++
Fundus findings
Active vasculitis
Occlusive vasculitis
with active retinitis
with macular edema
June 2012

Fundus fluorescine angiography advised
 Oral prednisolone dose hiked up
 ? ? other causes
Tests done:
 C-ACNA: negative
 P- ANCA: negative
 HLA B51: negative
July 2012
 Oral steroid dose increased
 Left eye sectoral panretinal
photocoagulation done around area of
neovascularization
 Anti TB treatment continued
August 2012

Sudden reduction in vision in Left eye
Right eye
Left eye
BCVA
6/6; N6
CF 1 mt; N36
IOP
10
12
Anterior segment
quite
quite
Fundus findings
Resolving vasculitis Vitreous hemorrhage
August 2012
August to September 2012
 August 2012
- right eye : vision maintained; disease stabilized
- Left eye: non resolving vitreous haem
 September 2012
- Left eye: Pars plana vitrectomy with membrane
peeling with Endo laser application done under steroid
cover
- Vitreous sample taken for Polymerase chain
reaction(PCR) for Mycobacterium Tuberculosis
Diagnosis after vitrectomy
 PCR for M. Tuberculosis : positive
 Mantoux Test : positive
 QuantiFeron TB gold test : positive
Presumed Tuberculous retinal periphlebitis
Problems
 Eales' disease v/s presumed tuberculous periphlebitis
 Negative Mantoux test does not exclude Tuberculosis
 QuantiFERON TB gold test : adds to the diagnosis
 PCR of vitreous biopsy for MPB 64 diagnostic
 Presumed tuberculous periphlebitis most common
cause for Eales disease.
Follow-up: November 2012
Right eye
Left eye
BCVA
6/6; N6
6/9, N6
IOP
10
12
Anterior segment
quite
quite
Fundus findings
Resolving vasculitis Resolving vasculitis
 continued on oral steroids tapering dose
Follow-up: November 2012
Follow-up: March 2013
Right eye
Left eye
BCVA
6/6; N6
6/7.5, N6
IOP
8
9
Anterior segment
WNL
quite
Fundus findings
Resolving vasculitis Resolved vasculitis
continued on oral prednisolone 10mg/day: stopped
after 2 months
Follow-up: March 2013
Follow-up: November 2013
 FFA done: no active vasculitis
 Off oral steroids >6 months
Right eye
Left eye
BCVA
6/6; N6
6/6; N6
IOP
8
8
Anterior segment
WNL
quite
Fundus findings
Resolved vasculitis
Laser marks with
resolved vasculitis
Follow-up: November 2013
Discussion
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Eales disease is defined as idiopathic inflammatory Retinal
vasculitis with peripheral retinal revascularization primarily
affecting the peripheral retina.
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It has high male preponderance
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Etiopathogenesis of Eales’ disease is still controversial and
ill-understood.
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Tuberculosis is considered to be the most important cause for
eales disease as evidenced by molecular micro biological
studies.
Conclusion
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Treatment with anti tuberculous treatment along with oral
steroids treatment is very useful especially in developing
countries with high prevalence of tuberculosis
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Prompt retinal photocoagulation of the area of
neovascularization and capillary non perfusion helps in
preventing the complications
Conclusion
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It is in the nature of the disease to have recurrences
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Therefore it is prudent to have regular follow ups for early
diagnosis of recurrence of vasculitis and complications like
peripheral neovascularization and vitreaous hemorrhage