Neuro-ophthalmic manifestations in a cohort of Ebola virus disease survivors from Sierra Leone: Ocular implications during convalescence

• Published in: Heliyon
• Main Authors: Nam V. Nguyen, Tolulope Fashina, Ye Huang, Casey Randleman, Jean-Claude Mwanza, Jalikatu Mustapha, Matthew Jusu Vandy, Lloyd Harrison-Williams, Brent R. Hayek, Ian Crozier, Rod Foroozan, Jessica G. Shantha, Steven Yeh
• Format: Article
• Language: English
• Published: Elsevier 2025-08-01
• Subjects: Cranial nerve abnormalities; Ebola virus; Ebola virus disease survivors; Optic nerve abnormality
• Online Access: http://www.sciencedirect.com/science/article/pii/S2405844025019838

Background: We aim to characterize the spectrum of neuro-ophthalmic manifestations and their impact on visual acuity in a cohort of Ebola virus disease (EVD) survivors from the Western African outbreak from 2013 to 2016. Methods: Patients, who previously underwent screening for enrollment in the Ebola Virus Persistence in Ocular Tissues and Fluids Study (EVICT study), were eligible for this post-hoc analysis. A review of collected data was performed, and neuro-ophthalmic manifestations including afferent pupillary defect, motility problems, and optic nerve diseases (optic pallor or atrophy) were analyzed. Statistical analysis was performed using Microsoft Excel (Microsoft Corporation, Redmond, WA); a p-value <0.05 was considered significant. Findings: A total of 184 eyes of 115 patients were included in the analysis. The mean age was 32·2 ± 15·8 years, and the mean logMAR was 0·34 ± 0·68; Snellen visual acuity of 20/40. Of 184 eyes, twelve (6·5 %) eyes of 8 patients had optic nerve diseases, of which 4 had bilateral disease. The mean logMAR was significantly worse in patients with optic nerve disease (1·46 ± 1·21) than in those without (0·26 ± 0·55), p-value = 0·008. Ocular motility issues were identified in 11 of 115 patients (9·6 %), which included exotropia (n = 9), esotropia (n = 1), and vertical gaze palsy (n = 1). Interpretation: In this post-hoc analysis, we identified a subset of EVD survivors with optic nerve diseases and motility disorders. Patients with optic nerve pathology showed worse visual acuity with severe vision impairment and rare association with neurologic symptoms.