Blurred Vision, West Nile Virus, Eye Stroke

[Sunny51]

A little over 2 mo. ago I started to experience soreness in my left eye. There was movement in the left corner of my eye There also was a reddish brown film covering the lower 1/8 of my eye. This continued to progress until a cloud covered my whole eye. Although it is less dense in the lower half than it was originally, the blurryness persists. I have been to a retinal specialist  (healthy retina/macula) and an neuro-opthamologist who put me on Cellebrex, an MRI, blood tests, and a lumbar puncture.  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." I tested positive for WNV (past episode).  (IgG He2.44/ IgM .06). The LP results showed 4 CSF O- Bands unique to the CSF. He did not think I had MS because the 2 clinical tests were negative for MS. He thought the bands might be from the WNV. The Myelin Basic Protein was .45 and the IgG Index was .44. About 3 weeks after the eye problem started I became extremely ill. I was diagnosed with sinusitis. I had no energy, a low fever--but was hot and cold. The cloud continued to advance until it covered my entire left eye and still does. I am still on Cellebrex, but toward the end of the day and when it wears off, I feel the swelling in my L eye and some in my R eye as well. They have not found any of the usual underlying causes for the eye stroke--high blood pressure, diabetes, auto-immune disease, etc. 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? What tests, treatments, doctors, etc.? Could it be WNV encephalitis or meningitis? I was exposed to bat guano and had traveled to tropics.

[Shazia Alam, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine you, I cannot comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

I’m not so sure about WNV causing your symptoms.  Usually it causes acute neurological clinical syndromes, such as meningitis, encephalitis, and paralysis, and although we don’t know the complete long term complications, common complaints tend to be fatigue.  However, I know you state that you tested positive, but it doesn’t sound like you had a case of encephalitis or meningitis associated with the WNV.  

Your eye symptoms may be related to the condition of Anterior ischemic optic neuropathy (AION).  This is a condition involving vision loss due to damage of the optic nerve.  Risk factors include cardiovascular risk factors:  HTN, Hyperlipidemia (triglyceridemia), Diabetes, tobacco use.  Usually this presents suddenly and upon awakening and noticed in one eye.  Vision in that eye is obscured by a dark shadow, often involving just the upper or lower half of vision, usually the area towards the nose.  This may recur in the other eye also.  

Some physicians will try a medication called Aspirin or Pletal to prevent recurrence.  I would recommend getting rechecked by a neuro-ophthalmologist, especially since these symptoms are progressive.  In addition, if not already done, get your thyroid function tests checked out.  In addition, following up with an Infectious Disease Specialist may also be a good idea.

I hope this information was helpful.  Best of luck.  

[Sunny51]

Thank you for your very helpful answer.  Actually extreme fatigue was one of my symptoms.  All I could do was lay in bed for about 3 weeks.  Also my neck and shoulder on the  left side were swollen and stiff, and my whole left side of my face including ear and nose felt inflamed.  Since it was my left eye that was inflamed it seemed like this might be related.  My other symptoms were low fever, general feeling of malaise, hot flushes and chills, elevated heart beat and blood pressure.  Could any of these things be associated with WNV or associated menengitis or ensephalitis?  Thank you--Sunny51