Ebola Virus

Ebola virus disease (EVD) was first discovered in 1976 when cases of hemorrhagic fever occurred near the Ebola River in the Democratic Republic of Congo. The West Africa Ebola outbreak of 2013–2016 involved over 28,000 reported cases and over 11,000 recorded deaths, mainly in the countries of Guinea, Liberia, and Sierra Leone. The Ebola virus is believed to be transmitted by fruit bats and affects humans and nonhuman primates. Of the 5 known viruses belonging to the Ebolavirus genus, 4 are known to cause disease in humans, and all are members of the Filoviridae family of single-stranded RNA viruses.

The Ebola virus can be contracted through contact with the blood, body fluid, or tissue of infected bats, primates, or humans. The virus can penetrate broken skin or mucous membranes, and infection can occur when touching infected blood, body fluids, or contaminated objects. Early symptoms of infection appear 2–21 days after exposure to the virus and include fever, chills, muscle aches, headache, and weakness. Hemorrhagic conjunctivitis is a known presentation of infection. Later symptoms include rash, nausea, emesis, diarrhea, bruising, and bleeding, with eventual multisystem organ failure and death.

Infection of blood or body fluids can be confirmed by PCR, ELISA, or Ebolavirus immunoglobulin testing.

Post-Ebola virus syndrome in patients who have recovered from EVD includes joint, muscle, and chest pain, neurological problems, and ocular complications.

Ophthalmic considerations The most common ocular manifestation of Ebola virus disease (EVD) is uveitis, which may lead to impaired vision or loss of vision. Other known sequelae include cataract, retinal scarring, optic neuropathy, hypotony, and phthisis bulbi. The CDC recommends taking the highest-level precautions when treating patients with EVD. Ophthalmologists working in endemic areas should suspect Ebola virus infection when encountering patients with hemorrhagic conjunctivitis. The ophthalmologist treating patients with EVD or post-Ebola virus syndrome should assume the virus remains active in the eye for months following the initial infection and should consult the CDC for the most current guidelines.

• Shantha JG, Crozier I, Yeh S. An update on ocular complications of Ebola virus disease. Curr Opin Ophthalmol. 2017;28(6):600–606.

• Van Gelder RN, Margolis TP. Ebola and the ophthalmologist. Ophthalmology. 2015;122(11):2152–2154.

• Varkey JB, Shantha JG, Crozier I, et al. Persistence of Ebola virus in ocular fluid during convalescence. N Engl J Med. 2015;372(25):2423–2427.

Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.