Blurred Vision, West Nile Virus, Eye Stroke

[Sunny51]

I have a very complicated case and if anyone has had any similiar symptons from West Nile Virus or other ideas on what is going on, I would appreciate it.  

A little over 2 months ago I started to experience soreness in my left eye.  There was movement in the left corner of my eye--(I kept thinking I was seeing something like a black cat--but of course there was nothing),  There also was a reddish brown film covering the lower 1/8 of my eye.  I went to the eye doctor and he said my left eye was very swollen and that the right eye was a little swollen. He said I had allergies and prescribed over the counter drops. After a week with no improvement, I went back and another doctor said she thought I might have a detached retina and referred me to a retinal specialist.  He did all sorts of tests and determined that my retina and macula were fine but that my optic nerve was inflamed.  His dx was optic neuritis.  He referred me to a neuro-opthamologist who immediately put me on Cellebrex (anit-inflammatory)  and ordered an MRI.  By this time I was 3 weeks into the episode.  Shortly after my visit to the retina specialist, the cloud at the bottom of my eye moved up to cover the entire lower half of my left eye, Four days after the retinal specialist visit, I saw the neuro-opthamologist.  He said my MRI was normal except for "soft tissue thickening and enhancement anterior to the globes suggestive of periorbital edema.  Both optic nerves appeared healthy."  He thought that I most likely had had an "eye stroke"--"nonprogressive nonarteric anterior ischemic optic neuropathy involving the left eye."  "Optic neuritis is a less likely diagnostic consideration."  

He ordered a bunch of blood tests and the only thing I tested positive for was West Nile Virus.  He thought this was from a past episode.  (IgG 2.44/ IgM .06).  (Another doctor has suggested that although it was a past incidence, it probably was in the last few months.) He also eventually ordered a lumbar puncture to test for MS.  The results showed 4 CSF oligoclonal Bands unique to the CSF.  He said he did not think I had MS because the 2 clinical tests were negative for MS.  In addiition the Myelin Basic Protein was .45 and the IgG Index was .44. He thought the bands might be from the WNV.  

About 3 weeks after the eye problem started I became extremely ill.  I was diagnosed with sinutits.  I had no energy,
a low fever--but was so hot I had to sleep out side, then chills.  I had a rapid heart beat at times. The cloud continued to advance until it covered my entire left eye.   However, it became more transparent in the lower half of my eye.  However, in 3 weeks my vision went from 20/20 to 20/70 because of the blurryness.

Now, over 2 months into this my vision is still blurry.  I am still on Cellebrex, but toward the end of the day and when it wears off, I feel the swelling in my left eye and it seems like some in my right eye as well.  My other symptoms have subsided except my heartbeat is running high for me--usually 75--now 90 to 100.  They have not found any of the usual underlying causes for the eye stroke--high blood pressure, diabetes, auto-immune disease, etc.

So finally to my questions:  Could this all be related to WNV?  Should I still have inflammation after over 2 months?  Is there anything else that can be done to relieve the inflammation, help with my vision, and prevent deterioration in my right eye?  I don't know what to do next.  It seems like there may be some underlying cause that may be being missed.  Sorry for the length of this--it is complicated--Sunny51

[John C Hagan III, MD, FACS, FAAO]

Histo can damage the eye but its relatively easy to diagnose and is due to abnormal blood vessels (neovascularization) in the retina or around (not in) the optic nerve. So its not likely at all. ANAION can come on suddenly or slowly.

JCH MD

[Sunny51]

Thank you---reading past comments, a couple people had had serious vision problems related to WNV so I wondered. My doctor thinks the evidence points to an eye stroke rather than optic neurietis. I am also 58--the age group for that. I am just concerned that the inflammation is continuing for over 2 months and may be affecting my other eye.  Is this normal for either eye stroke or optic neuritis, this condition has been gradually progressive rather than sudden.  Could histoplasmosis cause this?  I was in a cave with bat guano a couple weeks before this started.  Thanks--Sunny51

[John C Hagan III, MD, FACS, FAAO]

I have not managed a case of WNV however I've just reviewed the disease on emedicine.com and optic neuritis is not part of the disese spectrum so its not likelythe eye problem is due to WNV.