Rubella and eye disease in children

When a woman becomes pregnant and develops infectious rubella, especially in the early stages of pregnancy, the incidence of a symptom complex known as congenital rubella syndrome increases dramatically.

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Congenital rubella syndrome

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

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

Cataracts

Bilateral cataracts occur in 75% of cases. Cataracts are usually diffuse or manifest as gross opacities of the nucleus and cortical layers. Treatment of patients is basically no different from that for other congenital cataracts: special attention is paid to intraocular pressure due to the possibility of developing glaucoma. In the early postoperative period, surgical treatment of cataracts increases the risk of endophthalmitis, to avoid which the technique of complete lensectomy and the use of steroid drugs, both local (installations, subconjunctival injections) and general use, are preferable.

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Pigmentary retinopathy

Often occurs in congenital rubella syndrome, is bilateral. Manifests itself as a slight decrease in vision. Electroretinogram, as a rule, does not reveal pathological changes. Discoid degeneration may develop later.

Keratitis

Severe forms of keratitis, causing corneal scarring, are extremely rare. As a rule, keratitis is quite mild and causes transient corneal opacities, often mistaken for the consequences of the glaucoma process. Opacities resolve spontaneously within a period of several days to several weeks.

Glaucoma

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

Iris hypoplasia

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

Congenital rubella syndrome is now rare due to mandatory and widespread vaccination.

Diagnosis of rubella

Diagnosis is usually based on a history of maternal rash and fever during pregnancy or on the finding of symptoms compatible with congenital rubella syndrome in the child. Rubella virus may be isolated from urine, saliva, or aspirated lens masses (before age 4 years). Children with congenital rubella syndrome retain specific immunoglobulin M (IgM).

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Treatment of rubella

Cataracts are usually operated at an early age, under the cover of steroid drugs. In the presence of a glaucomatous process, it is important to exclude keratopathy, characteristic of rubella, as a cause of corneal opacities. Regular measurement of intraocular pressure is mandatory. Treatment of children with congenital rubella syndrome involves a comprehensive approach involving doctors of other specialties.