Welcome to question of the day #11

Eyetools question of the day #11

Measles is a highly infectious viral illness that can be very unpleasant and sometimes lead to serious complications. It usually affects young children. In some countries measles is rare because of vaccination while in other countries it is common because of a lack of vaccination.

Anyone can get measles if they have not been vaccinated or have not had it before, although it’s most common in young children. The initial symptoms are:

Ø cold-like symptoms, such as a runny nose, sneezing and a cough
Ø sore, red eyes that may be sensitive to light
Ø a high temperature (fever), which may reach around 40C
Ø small greyish-white spots on the inside of the cheeks.

A few days later, a red-brown blotchy rash will appear. This usually starts on the head or upper neck before spreading outwards to the rest of the body.

Measles can be unpleasant, but will usually pass in about 7 to 10 days without causing any further problems. The body builds up immunity to the virus and it’s highly unlikely to occur again. But it can lead to serious and potentially life-threatening complications in some people.It can sometimes result in a strabismus.

Some older patients with childhood strabismus have told me that they were informed by their parents that they had straight eyes until they caught measles and then they developed an eye turn which stayed even after they recovered from the measles.The main eye text books and research literature are silent on this topic probably because strabismus onset due to measles is rare in these times. The best information I can find is from healthcare literature aimed at the general public.

Measles has a predilection for children younger than five years old and it is in this age group that strabismus sometimes presents during the period of illness. It is secondary due to measles and no strabismus was present before the illness. It is likely that a tendency for a strabismus had been present but, prior to the measles, the child was able to keep both eyes straight. Measles is not the direct cause of the strabismus but the poor general health associated with it has reduced the ability to control the eyes, probably through a process that interferes with fusion and/or motor control centres in the brain.

A strabismus that remains after the child has recovered from measles could be due to a permanent reduction in fusion/motor control. As there won’t be a refractive element to the strabismus the only course of remediation to improve cosmesis would be extraocular muscle surgery.