- George N Papaliodis, MD
George N Papaliodis, MD
- Director, Ocular Immunology and Uveitis Service
- Harvard Medical School
Eales’ disease is a form of vasculitis typified by vascular inflammation in the peripheral retina. Because of its tendency to involve veins, the disorder has also been termed “periphlebitis retinae” and “idiopathic retinal periphlebitis.”
The clinical presentation, treatment, and prognosis of Eales' disease are distinct from those of other inflammatory conditions that involve the retina. Eales' disease must be distinguished from systemic disorders and infections as well as from other ocular syndromes that cause retinal vasculitis.
The clinical manifestations, diagnosis, and treatment of Eales’ disease will be reviewed here. Retinal vasculitis that occurs in association with systemic disorders, infections, and primary retinal diseases is discussed separately. (See "Retinal vasculitis associated with systemic disorders and infections" and "Retinal vasculitis associated with primary ocular disorders".)
Eales’ disease was described originally in England [1,2] but is observed much more commonly on the Indian subcontinent than in any other region. Eales’ disease has been estimated to occur in 1 of every 135 to 250 patients evaluated at tertiary eye care centers in India [3-5].
A striking male predominance is reported in most series [6,7]. However, in one series from North America, equal numbers of females and males were reported . The mean age at onset in most studies from India is between the age of 20 and 30 years, compared with approximately 40 years in America and Germany [8,9].
- Eales H. Retinal hemorrhages associated with epistaxis and constipation. Birmingham Med Rev 1880; 9:267.
- Eales H. Primary retinal hemorrhage in young men. Ophthalmic Rev 1882; 1:41.
- Putamma ST. Varied fundus picture of central retinal vasculitis. Trans Asia Pacific Acad Ophthalmol 1970; 3:520.
- Awasthi P, Mehrotra M, Srivastava SN. Ocular conditions in pulmonary tuberculosis patients in India. Acta XX Concillium Ophthalmologicum 1966; :1025.
- Badrinath SS, Honnatti MR. Vitrectomy in Eales' disease. Acta Int Cong Ophthalmol 1982; 24:536.
- Elliot AJ. 30-year observation of patients with Eale's disease. Am J Ophthalmol 1975; 80:404.
- Nagpal PN, Sharma RK, Joshi BS, Patel AM. Management of Eales' disease: Analysis of 800 cases (1,214 eyes). Asia Pac J Ophthalmol 1998; 10:11.
- Renie WA, Murphy RP, Anderson KC, et al. The evaluation of patients with Eales' disease. Retina 1983; 3:243.
- Spitznas M, Meyer-Schwickerath G, Stephan B. The clinical picture of Eales' disease. Albrecht Von Graefes Arch Klin Exp Ophthalmol 1975; 194:73.
- Biswas J, Therese L, Madhavan HN. Use of polymerase chain reaction in detection of Mycobacterium tuberculosis complex DNA from vitreous sample of Eales' disease. Br J Ophthalmol 1999; 83:994.
- Madhavan HN, Therese KL, Gunisha P, et al. Polymerase chain reaction for detection of Mycobacterium tuberculosis in epiretinal membrane in Eales' disease. Invest Ophthalmol Vis Sci 2000; 41:822.
- Sen A, Paine SK, Chowdhury IH, et al. Assessment of gelatinase and tumor necrosis factor-α level in the vitreous and serum of patients with Eales disease: role of inflammation-mediated angiogenesis in the pathogenesis of Eales disease. Retina 2011; 31:1412.
- Saxena S, Pant AB, Khanna VK, et al. Interleukin-1 and tumor necrosis factor-alpha: novel targets for immunotherapy in Eales disease. Ocul Immunol Inflamm 2009; 17:201.
- Atmaca LS, Batioglu F, Atmaca Sonmez P. A long-term follow-up of Eales' disease. Ocul Immunol Inflamm 2002; 10:213.
- Charamis J. On the classification and management of the evolutionary course of Eales' disease. Trans Ophthalmol Soc U K 1965; 85:157.
- Howe LJ, Stanford MR, Edelsten C, Graham EM. The efficacy of systemic corticosteroids in sight-threatening retinal vasculitis. Eye (Lond) 1994; 8 ( Pt 4):443.
- Biswas J, Sharma T, Gopal L, et al. Eales disease--an update. Surv Ophthalmol 2002; 47:197.
- Bali T, Saxena S, Kumar D, Nath R. Response time and safety profile of pulsed oral methotrexate therapy in idiopathic retinal periphlebitis. Eur J Ophthalmol 2005; 15:374.
- Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. The Diabetic Retinopathy Study Research Group. Ophthalmology 1981; 88:583.
- Chew EY, Ferris FL 3rd, Csaky KG, et al. The long-term effects of laser photocoagulation treatment in patients with diabetic retinopathy: the early treatment diabetic retinopathy follow-up study. Ophthalmology 2003; 110:1683.
- Kumar A, Tiwari HK, Singh RP, et al. Comparative evaluation of early vs. deferred vitrectomy in Eales' disease. Acta Ophthalmol Scand 2000; 78:77.
- Pathengay A, Pilli S, Das T. Intravitreal triamcinolone acetonide in Eales' disease: a case report. Eye (Lond) 2005; 19:711.
- CLINICAL FEATURES
- Clinical stages
- Laboratory tests
- Serologic assays
- Imaging studies
- - Chest imaging
- - Fluorescein angiography
- - Ultrasonography
- - Ocular coherence tomogram
- DIFFERENTIAL DIAGNOSIS
- Watchful waiting
- Medical therapy
- - Systemic glucocorticoids
- - Periocular glucocorticoid injections
- - Methotrexate
- Laser photocoagulation
- Vitreous surgery
- - Intravitreal injections
- SUMMARY AND RECOMMENDATIONS
- Clinical features