Rubella and eye diseases in children

Disease of a woman during pregnancy with infectious rubella, especially in the early stages of pregnancy, dramatically increases the incidence of the symptom complex, known as congenital rubella syndrome.

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Syndrome of congenital rubella

1. Pathology of the organ of vision:
   • cataracts;
   • pigmentary degeneration of the retina;
   • glaucoma;
   • microphthalmos;
   • corneal pathology;
   • transient edema of the cornea.
2. General pathology:
   • congenital heart defects;
   • loss of hearing;
   • thrombocytopenia;
   • hepatosplenomegaly;
   • diabetes;
   • calcification of the brain;
   • microcephaly;
   • mental retardation.

The earlier rubella appeared during pregnancy, the more severe the systemic damage and pathology of the organ of vision.

Cataracts

The emergence of bilateral cataracts is observed in 75% of cases. Cataracts, as a rule, have a diffuse character or are manifested by gross opacifications of the nucleus and cortical layers. Treatment of patients basically does not differ from that of other congenital cataracts: special attention is paid to intraocular pressure in connection with the possibility of glaucoma development. In the surgical treatment of cataracts in the early postoperative period, the risk of endophthalmitis is increased, to avoid which the technique of full lenseectomy and the use of steroid preparations as local (installations, subconjunctival injections) and general purpose are preferred.

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Pigment Retinopathy

Often occurs with congenital rubella syndrome, has a bilateral character. It shows a slight decrease in vision. Electroretinogram, as a rule, does not reveal pathological changes. Later, discoid degeneration may develop.

Keratites

Heavy forms of keratitis, which cause scarring of the cornea, are extremely rare. As a rule, keratites have a fairly easy flow and cause transient opacities of the cornea, often mistaken for the consequences of the glaucomatous process. The turbidity resolves spontaneously within the time frame from several days to several weeks.

Glaucoma

Occurs with congenital rubella syndrome with a frequency of about 10%. In the initial stage, the effect can be given by the appointment of acetazolamide (diacarb) and hypotensive instillations, but the main method of treatment is ultimately surgical intervention. Beta-blockers for these children are prescribed with caution, in connection with the possibility of pulmonary and cardiac pathology.

Hypoplasia of the iris

By itself, it has little effect on visual functions, but may indicate a severe intraocular pathology.

Syndrome of congenital rubella is currently rare in connection with mandatory and widespread vaccination.

Diagnosis of rubella

The diagnosis is usually based on anamnesis data indicating the appearance of a rash and fever during pregnancy in the mother or on the detection of symptoms comparable to congenital rubella syndrome in a child. Rubella virus can be isolated from urine, saliva or aspirated lens masses (up to 4 years of age). Specific immunoglobulin M (IgM) is preserved in children with congenital rubella syndrome.

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Treating rubella

Cataracts usually operate at an early age, under the cover of steroid drugs. In the presence of glaucomatous process, it is important to exclude keratopathy, characteristic of rubella, as the cause of corneal opacities. A regular measurement of intraocular pressure is mandatory. Treatment of children with congenital rubella syndrome implies an integrated approach involving physicians of other specialties.