Eales Disease Workup

  • Author: Daniel B Roth, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 25, 2010
 

Laboratory Studies

  • No clinical laboratory studies are available to confirm the diagnosis of Eales disease, as it is a diagnosis of exclusion. However, laboratory studies are necessary to exclude other similar entities.
    • Blood glucose or fasting blood glucose to rule out diabetes mellitus
    • Complete blood count to rule out hemoglobinopathies
    • Sickle cell preparation and serum protein electrophoresis to rule out sickle cell disease
    • Angiotensin converting enzyme and lysozyme to rule out sarcoidosis
    • Antinuclear antibody, rheumatoid factor, and erythrocyte sedimentation rate to rule out collagen vascular disease
    • Tuberculin skin testing may be useful, as patients with Eales disease have a higher incidence of tuberculin hypersensitivity, despite the absence of a history of tuberculosis.
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Imaging Studies

  • Fluorescein angiography (FA) can be useful to determine the nature of the microvascular abnormalities associated with Eales disease. Neovascularization and exudative sheathing of vessels will leak fluorescein dye. The area and degree of nonperfusion can be determined on FA and help delineate where to apply laser photocoagulation, when indicated. Note the image below. Eales disease. Fluorescein angiogram of late leakaEales disease. Fluorescein angiogram of late leakage from peripheral retinal neovascularization.
  • Echographic evaluation often is useful to evaluate the retina in the setting of vitreous hemorrhage. When the details of the fundus are obscured, ultrasound can determine the presence or absence of a retinal detachment or vitreoretinal traction.
  • Chest radiography may be considered to rule out sarcoidosis or a history of tuberculosis, in the setting of a positive tuberculin skin test.
  • Magnetic resonance imaging (MRI) of the brain may reveal multifocal white matter abnormalities, but this study probably is not warranted in the absence of neurologic symptoms.
  • Optical coherence tomography (OCT) is a useful modality to image the macular morphology and architecture. Any possible cystoid changes in the macula contributing to visual loss may be detected with OCT.
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Other Tests

  • Studies have found an increased level of oxidation and peroxidation products in vitreous samples from patients with Eales disease (ie, an increased amount of thiobarbituric acid reacting substances). A decreased level of antioxidant enzymes also has been found in vitreous samples from patients with Eales disease (ie, a decreased amount of reduced glutathione, superoxide dismutase, and glutathione peroxidase).[8, 9]
  • Hearing and balance should be tested formally, as patients with Eales disease may have associated vestibuloauditory dysfunction.
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Contributor Information and Disclosures
Author

Daniel B Roth, MD  Assistant Professor, Department of Ophthalmology, University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School, Retina Vitreous Center

Daniel B Roth, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Russell P Jayne, MD  Consulting Vitreoretinal Surgeon, The Retina Center at Las Vegas

Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, and American Society of Retina Specialists

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians & Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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  2. Phanthumchinda K. Eales' disease with myelopathy. J Med Assoc Thai. Apr 1992;75(4):255-8. [Medline].

  3. Sawhney IM, Chopra JS, Bansal SK, Gupta AK. Eales' disease with myelopathy. Clin Neurol Neurosurg. 1986;88(3):213-5. [Medline].

  4. Gordon MF, Coyle PK, Golub B. Eales' disease presenting as stroke in the young adult. Ann Neurol. Aug 1988;24(2):264-6. [Medline].

  5. Kutsal YG, Altioklar K, Atasu S, Kutluk K, Atmaca L. Eales' disease with hemiplegia. Clin Neurol Neurosurg. 1987;89(4):283-6. [Medline].

  6. Antiguedad A, Zarranz JJ. [Eales' disease involving central nervous system white matter]. Neurologia. Aug-Sep 1994;9(7):307-10. [Medline].

  7. Katz B, Wheeler D, Weinreb RN, Swenson MR. Eales' disease with central nervous system infarction. Ann Ophthalmol. Dec 1991;23(12):460-3. [Medline].

  8. Bhooma V, Sulochana KN, Biswas J, Ramakrishnan S. Eales' disease: accumulation of reactive oxygen intermediates and lipid peroxides and decrease of antioxidants causing inflammation, neovascularization and retinal damage. Curr Eye Res. Feb 1997;16(2):91-5. [Medline].

  9. Sulochana KN, Biswas J, Ramakrishnan S. Eales' disease: increased oxidation and peroxidation products of membrane constituents chiefly lipids and decreased antioxidant enzymes and reduced glutathione in vitreous. Curr Eye Res. Sep 1999;19(3):254-9. [Medline].

  10. .

  11. Agrawal S, Agrawal J, Agrawal TP. Intravitreal triamcinolone acetonide in Eales disease. Retina. Feb 2006;26(2):227-9. [Medline].

  12. Chanana B, Azad RV, Patwardhan S. Role of intravitreal bevacizumab in the management of Eales' disease. Int Ophthalmol. Feb 2010;30(1):57-61. [Medline].

  13. Moyenin P, Grange JD. [Eales' syndrome. Clinical aspects, therapeutic indications and course of 29 cases]. J Fr Ophtalmol. 1987;10(2):123-8. [Medline].

  14. Küçükerdönmez C, Akova YA, Yilmaz G. Intravitreal injection of bevacizumab in Eales disease. Ocul Immunol Inflamm. Jan-Feb 2008;16(1):63-5. [Medline].

  15. Kumar A, Sinha S. Rapid regression of disc and retinal neovascularization in a case of Eales disease after intravitreal bevacizumab. Can J Ophthalmol. Apr 2007;42(2):335-6. [Medline].

  16. Magargal LE, Walsh AW, Magargal HO, Robb-Doyle E. Treatment of Eales' disease with scatter laser photocoagulation. Ann Ophthalmol. Aug 1989;21(8):300-2. [Medline].

  17. Spitznas M, Meyer-Schwicherath G, Stephan B. Treatment of Eales' disease with photocoagulation. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1975;194(3):193-8. [Medline].

  18. Shanmugam MP, Badrinath SS, Gopal L, Sharma T. Long term visual results of vitrectomy for Eales disease complications. Int Ophthalmol. 1998;22(1):61-4. [Medline].

  19. Das T, Namperumalsamy P. Combined photocoagulation and cryotherapy in treatment of Eales' retinopathy. Preliminary report. Indian J Ophthalmol. 1987;35(5-6):108-18. [Medline].

  20. Eller AW, Bontempo FA, Faruki H, Hassett AC. Peripheral retinal neovascularization (Eales disease) associated with the factor V Leiden mutation. Am J Ophthalmol. Jul 1998;126(1):146-9. [Medline].

  21. Elliot AJ. 30-year observation of patients with Eale's disease. Am J Ophthalmol. Sep 1975;80(3 Pt 1):404-8. [Medline].

  22. Gieser SC, Murphy RP. Eales disease. In: Principles and Practice of Ophthalmology. Vol 2. 1994:791-795.

  23. Masson C, Denis P, Prier S, Martin N, Masson M, Cambier J. [Eales' disease with neurologic disorders]. Rev Neurol (Paris). 1988;144(12):817-9. [Medline].

  24. Renie WA, Murphy RP, Anderson KC, et al. The evaluation of patients with Eales' disease. Retina. Fall-Winter 1983;3(4):243-8. [Medline].

  25. Singhal BS, Dastur DK. Eales' disease with neurological involvement Part 1. Clinical features in 9 patients. J Neurol Sci. Mar 1976;27(3):313-21. [Medline].

  26. Spitznas M, Meyer-Schwickerath G, Stephan B. The clinical picture of Eales' disease. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1975;194(2):73-85. [Medline].

 
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Eales disease. Fundus photo of the peripheral retina, revealing vascular tortuosity and peripheral retinal neovascularization.
Eales disease. Fluorescein angiogram of late leakage from peripheral retinal neovascularization.
 
 
 
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