Measles and its effects on the eye of children

1. MEASLES AND THE EYES.
Presented by Victoria Ikechukwu

2. MEASLES

3. Definition
Measles:- Is a childhood
infection caused by a virus
(i.e a single stranded,
enveloped RNA virus with 1
serotype- it is classified as a
member of the genus
Morbillivirus in the
Paramyxoviridac Family.
Humans are the only natural
hosts of measles virus. Once
quite common, measles can
now almost be prevented

4. Mode of Transmission
Person to person transmission. This
virus lives in the nose and throat (i.e
mucus of an infected person it can
spread to others through coughing and
sneezing. Transmitted by direct contact
with infectious droplets or by Airbonne
spread. Measles virus can remain
infectious in the air for up to two hours
after an infected person leaves an area.
Its highly Contagious

5. It is so contagious that if one
person has it, up to 90% of the
people close to that person who
are not immune to it will also
become infected.
Infected people can spread
measles to others from four days
before and through four days
before the rash appears.

6. Mortality/Morbidity Rate
Jan 2022, 254 cases of measles were confirmed in Nigeria
2022 9,000 cases, (March – August 2022 – 9,373 cares as at
12 Oct, 2022)
WHO 2018 140, 000 died from measles worldwide.
High mortality is common in eventures with low income and
weak health facilities. One of the most contagious disease.

8. Clinical Manifestation
There takes around 10 -14 days after exposure to the virus
1. Fever 40.5° - 41.5° = 105° F
2. Coryza
3. Malaise
4. Dry cough (hyperpyrexia)
5. Koplik’s spots: tiny white spot with bluish acute
6. Sore throat centers on a red background found inside the mouth.
7. The 3C’s = Cough, Coryza and conjunctivitis

10. The infection occurs in stages over 2 to 3 weeks
1. Infection and Incubation:- For the first 10-14 days after
infection the measles virus spreads in the body. There are
no signs or measles during this time.
2. Non-specific signs and symptoms:- measles typically begins
a mild to moderate fever, after with a persistent cough, a
running nose. (Coryza) inflamed (Conjuctivitis) and a sure
throat. This relatively mild illness may last 2 to 3 days.

11. Its Effects on the Eyes
A study estimated that measles causes to 60,000
cases of blindness a year. Through measles is just re-
emerging as a threat in developed countries. The
disease has long been leading cause of childhood
blindness worldwide. Poor access to measles
vaccination and malnutrition often correlates with
higher rates of blindness in the most affected
countries.

12. There are some ways the virus can harm the eyes and affect
vision.
1. Conjunctivitis
2. Corneal scaring
3. Keratitis
4. Rehnopathy
5. Optic neuritis
6. Blindness

13. Conjunctivitis (infective)
The commonest cause of red eye is one of the early and
common symptoms of measles is inflamed eyes
(conjunctivitis). This type of “pink eye” usually develops along
fever, cough and coryza before the rashes appears.
The inflammation of the conjunctiva, which can be extremely
contagious when small blood vessels in the conjunctiva
becomes inflamed, there are more visible.
Cause: Commonly by a bacteria or viral infection, an allergic
reaction.

14. Clinical manifestation
1. Redness in one or both eyes
2. Itching in one or both eyes
3. A gritty feeling in one or both eyes
4. Discharge in one or both eyes
5. Tearing

15. Treatment
Nursing management
 History taking: timing of onset
 Prodromal symptoms i.e. unilateral or bilateral
 Past episodes, type of discharge
 Obtain visual acquity
 Apply cool compress
 Educate patient on the disease

17.  Do not share personal belongings/ care items
 Administer medication as prescribed
 Encourage hand hygiene
 Use of sun glasses white out

18. Treatment
Treatment of both viral and bacterial conjunctivitis should
include patient education to decrease the rate of
transmission.
- Antibiotic options are available as liquid so intious and
topical ointment
- Anti-Viral medication (Therapy)

19. Realities: - inflammation of the cornea, often associated
with infective conjunctivitis
e.g. Acyclovir oral and both topical
800mg 5x a day.
Oral famciclovir 500mg + ds
‘’ Valacyclovir 1g + ds a day 7 – 10 days

20. Clinical Features
1. Irritation
2. Pain
3. Eye discharge
4. Photophobia
5. Visual Impurments
6. Epiphoria (teaning)

21. Nursing Management
- Obtain History
- Visual acuity
- Pera lyht exammation (Lids of Conjunction)
- Serve prescribed medications
- Health educates patient on the discase and treaties plan
- Anti-viral eyedrops/medications e.g. Acyclovir and oral
may be effective.
- Others are supportive care such as Artificial tear days

22. Corneal Scanning
The cornea is resilient and can typically heal from
mini abrasions. However, major cornea damage
can result in a cornea scar.
After major damage, clear corneal tissue may be
replaced by scar tissue or become occluded by
new blood vessels (a problem called
Neovascularization).

23. Clinical Manifestation
- Pain
- FB sensation
- Epiphora
- Blurred vision
- Photophobia
- Buring sensation in the eye
- Eye lid swelling – Redness

24. 1. Therapeutre - contact lens
- Tatooing
- Corneal Transplant
Optic Neuritis:- Inflammation of the optic neuritis is a rare
complication of measles that tayets the optic nerve. The optic
nerve is responsible to taking visual information produced by
the retina and sending it to the brain to be processed. When
the optic gets inflamed. It can cause eye pain, loss of colour
vision and temporary blindness. In adults usually one eye is
affected but in children both eyes are affected.

25. Signs and Symptoms
- Pain
- Loss of colour vision
- Visual field loss
- Blurring vision
- Loss of vision

26. Treatment
Optic Neuritis may resolve spontaneously without
treatment. If visual function is poor; a course of IV
methyl prednisolone may be given as prescribed.
This has been shown to spread recovery of visual
function. The usual course is 3 days, followed by a
few days of oral medications.

27. Some Helpful Investigation
OCT – Optical Coherence Tomography. It uses reflected light
to create pictures of the back of the eye.
Visual Evoked Response: - The doctor attaches electro delusive
to one’s head with small patches. The wire records one’s
brains response as he/she watch a screen that displays an
altemaling checkboard pattern. The test measures the speed
at which your optic nerve sends signals to your brain, its
damaged. They will more more slowly. Mostly, used in
patients’ multiple sclerosis.

28. Retinopathy: - Refers to disease of the Betina –
this involves the retina blood vessels. While rare;
there are documented cases where the measles
virus destroys the retina.

29. Signs and Symptoms
- Gradual worsening vision
- Loss of vision (colour)
- Floaters

30. Blindness
Measles is a leading cause of childhood blindness in
developing countries where immunization programs
for this disease are less established or often
interrupted by conflict. When compounded by
malnutrition, particularly vitamin A deficiency.
Measles is an associated with corneal scanning from
ulceration and keratitis, two of optic neuritis has also
been noted.

31. Prevention: - There is no specific anti-viral treatment for
measles making vaccination the best means of limiting the
spread of this disease.
CDC! Centre for Disease Control and Prevention, and World
Health Organization recommends measles vaccination.
Vit A treatment; children with severe cases (include those
requiring hospitalization) WHO suggest treatment of vit A on
the day of diagnosis and day after to prevent visual loss due to
eye complications.

32. 1. 50,000 IV for infants younger than 6 months of
age
2. 100,000 IV for infants younger than 6 to 11
months of age
3. 200,000 IV for children 12 months of age and
older.

33. Conclusion
Measles infections can harm the front and even
down to the back of the eye and possibly causing
vision loss or blindness. The need for proper and
safe adherence to childhood immunization cant be
over emphasized accurate and early diagnosis plus
prompt intervention can go along way.

34. References
- American Academy of Opthalmology
- Clinical Significance of Measles, A review, Journal of infectious
- International Opthalmology March 2014
- Measles Blindness, Survey of Opthalmology, 2014
- Mayo Clinic
- Comprehensive Opthalmology A-K Khurana
- Concise textbook ophthalmology – Affiong Awana

35. Thank you for listening.