Ophthalmic Manifestations and Causes of Vision Impairment in Ebola Virus Disease Survivors in Monrovia, Liberia

Published:December 01, 2016DOI:


      To describe the ocular findings, visual impairment, and association of structural complications of uveitis with visual impairment in a cohort of survivors of Ebola virus disease (EVD) in Monrovia, Liberia.


      Retrospective, uncontrolled, cross-sectional study.


      Survivors of EVD who were evaluated in an ophthalmology clinic at Eternal Love Winning Africa (ELWA) Hospital in Monrovia, Liberia.


      A cohort of EVD survivors who underwent baseline ophthalmic evaluation at ELWA Hospital were retrospectively reviewed for demographic information, length of Ebola treatment unit (ETU) stay, visual acuity (VA), and ophthalmic examination findings. For patients with uveitis, disease activity (active vs. inactive) and grade of inflammation were recorded according to Standardization of Uveitis Nomenclature criteria. The level of VA impairment was categorized according to World Health Organization classification for VA impairment as follows: normal/mild, VA 20/70 or better; moderate, VA 20/70–20/200; severe, VA 20/200–20/400; blindness, VA <20/400. Visual acuity, length of ETU stay, and structural complications were compared between EVD survivors with and without uveitis. Structural complications associated with moderate VA impairment or poorer were analyzed.

      Main Outcome Measures

      Frequency of ocular complications including uveitis and optic neuropathy in EVD survivors, level of VA impairment in EVD survivors with uveitis, and structural complications associated with VA impairment in EVD survivors.


      A total of 96 survivors of EVD were examined. A total of 21 patients developed an EVD-associated uveitis, and 3 patients developed an EVD-associated optic neuropathy. Visual acuity was blind (VA >20/400) in 38.5% of eyes with uveitis. Anatomic subtypes of uveitis included anterior, posterior, and panuveitis in 2, 13, and 6 patients, respectively. Examination findings associated with at least moderate visual impairment by World Health Organization criteria (VA <20/70) included keratic precipitates (P < 0.002), posterior synechiae (P < 0.002), vitritis (P < 0.005), and chorioretinal scars (P < 0.02).


      Survivors of EVD are at risk for uveitis, which may lead to secondary structural complications, visual impairment, and blindness. Eye care resources should be mobilized for EVD survivors in West Africa because of the frequency of this spectrum of disease complication and its potential for severe VA impairment and blindness.

      Acronyms and Abbreviations:

      ELWA (Eternal Love Winning Africa), ETU (Ebola treatment unit), EVD (Ebola virus disease), IOP (intraocular pressure), VA (visual acuity)
      To read this article in full you will need to make a payment


      Subscribe to Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Ebola situation report. World Health Organization: Ebola Situation Report, Geneva. Available at:; Accessed March 30, 2016.

        • Clark D.V.
        • Kibuuka H.
        • Millard M.
        • et al.
        Long-term sequelae after Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort study.
        Lancet Infect Dis. 2015; 15: 905-912
        • Qureshi A.I.
        • Chughtai M.
        • Loua T.O.
        • et al.
        Study of Ebola virus disease survivors in Guinea.
        Clin Infect Dis. 2015; 61: 1035-1042
        • Goeijenbier M.
        • van Kampen J.J.
        • Reusken C.B.
        • et al.
        Ebola virus disease: a review on epidemiology, symptoms, treatment and pathogenesis.
        Neth J Med. 2014; 72: 442-448
        • Kibadi K.
        • Mupapa K.
        • Kuvula K.
        • et al.
        Late ophthalmologic manifestations in survivors of the 1995 Ebola virus epidemic in Kikwit, Democratic Republic of the Congo.
        J Infect Dis. 1999; 179: S13-S14
        • Chancellor J.R.
        • Padmanabhan S.P.
        • Greenough T.C.
        • et al.
        Uveitis and systemic inflammatory markers in convalescent phase of Ebola virus disease.
        Emerg Infect Dis. 2016; 22: 295-297
        • Varkey J.B.
        • Shantha J.G.
        • Crozier I.
        • et al.
        Persistence of Ebola virus in ocular fluid during convalescence.
        N Engl J Med. 2015; 372: 2423-2427
        • Mattia J.G.
        • Vandy M.J.
        • Chang J.C.
        • et al.
        Early clinical sequelae of Ebola virus disease in Sierra Leone: a cross-sectional study.
        Lancet Infect Dis. 2016; 16: 331-338
        • Scott J.T.
        • Sesay F.R.
        • Massaquoi T.A.
        • et al.
        Post-Ebola syndrome, Sierra Leone.
        Emerg Infect Dis. 2016; 22: 641-646
        • Carod-Artal F.J.
        Post-Ebola virus disease syndrome: what do we know?.
        Expert Rev Anti Infect Ther. 2015; 13: 1185-1187
        • Tiffany A.
        • Vetter P.
        • Mattia J.
        • et al.
        Ebola virus disease complications as experienced by survivors in Sierra Leone.
        Clin Infect Dis. 2016; 62: 1360-1366
        • Jabs D.A.
        • Nussenblatt R.B.
        • Rosenbaum J.T.
        • Standardization of Uveitis Nomenclature (SUN) Working Group
        Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop.
        Am J Ophthalmol. 2005; 140: 509-516
      2. Change the definition of blindness. Available at: Accessed October 4, 2016.

        • Chertow D.S.
        • Nath A.
        • Suffredini A.F.
        • et al.
        Severe meningoencephalitis in a case of Ebola virus disease: a case report.
        Ann Intern Med. 2016; 165: 301-304
        • Tomkins-Netzer O.
        • Talat L.
        • Bar A.
        • et al.
        Long-term clinical outcome and causes of vision loss in patients with uveitis.
        Ophthalmology. 2014; 121: 2387-2392
      3. Clinical care for survivors of Ebola virus disease: Interim Guidelines. Available at:; Accessed October 4, 2016.

      Linked Article