Eales Disease Workup

Updated: Sep 28, 2018
  • Author: Jonathan C Tsui, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Workup

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. See the following:

  • 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 leaka Eales 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. In specific cases, high-resolution computed tomography of the chest may be helpful for further delineating pathology seen on equivocal chest radiographs. [16]

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. Changes in the macula contributing to visual loss may be detected with OCT, including macular edema and epiretinal membrane. In some cases, spectral-domain OCT has been able to detect changes that have not been evident on fluorescein angiography. [17]

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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). [18, 19]

Hearing and balance should be tested formally, as patients with Eales disease may have associated vestibuloauditory dysfunction.

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