Corneal and conjunctival abnormalities in a cohort of survivors from the Western African Ebola virus disease outbreak

Purpose: To characterize corneal and conjunctival abnormalities (CCAs) and their impact on visual acuity in a cohort of survivors from the Western African Ebola virus disease (EVD) outbreak.

Design: A post hoc analysis of 121 patients, who had previously undergone screening for the Ebola Virus Persistence in Ocular Tissues and Fluids study, was performed.

Methods: Patients underwent a comprehensive ophthalmic exam at the Lowell and Ruth Gess Eye Hospital in Freetown, Sierra Leone. Demographic (including age, sex, and the number of days spent in the Ebola treatment unit and examination (such as visual acuity, and ocular complications) data were collected and used for the analysis. Visual acuity was either uncorrected or corrected with spectacles. Descriptive and inferential statistical analyses were performed, and a p-value < 0.05 was considered statistically significant.

Results: A total of 242 eyes (121 patients) were included in this study. The mean age was 31.5 ± 16.1 years, and 70 % were female. Of 242 eyes, 28 (11.5 %) eyes of 15 patients (12.4 %) presented with at least one or more corneal or conjunctival abnormalities. Within eyes that demonstrated CCAs, the findings included dry eye (28.6 % of eyes), band keratopathy (25 % of eyes), and corneal scar (21.4 % of eyes). Corneal edema was found in 14.3 % of eyes, while pterygium and epithelial bullae were each found in 7.1 % of affected eyes. Patients without CCAs had better visual acuity compared to patients with CCAs although the difference was not statistically significant (0.82 ± 1.17 vs 1.01 ± 1.29, p = 0.4). A subset of patients with CCAs also reported ocular symptoms including eye pain, light sensitivity, excessive tearing, and blurry vision.

Conclusion: In this post hoc analysis, we observed CCAs in 12 % of EVD survivors. These findings highlight the potential for corneal and conjunctival sequelae during EVD survivorship and the need for ongoing ophthalmic care for this vulnerable population.