Ocular Symptoms in Glandular Fever

Abstract

OBSCURE though its ultimate cause may be, awareness of the widespread nature of the changes throughout the body prompts one to be on the look-out for unusual clinical signs in glandular fever. There have been no reports of its ocular manifestations in Great Britain since hyperaemia of the discs was first described by Clemens (1907). The most authoritative and recent account is that of Tanner (1954), who divides the complications into two groups: (1) those affecting the neuro-ophthalmic apparatus of the central nervous system; (2) those involving the eye and its adnexa. Group 1 is perhaps better known and includes extra-ocular muscle palsies, ptosis, nystagmus, disturbances of conjugate deviation, hemianopia, scotomata, hippus, papilloedema, and optic neuritis. Group 2 includes swollen tear-glands, conjunctivitis, eyelid and peri-orbital oedema, episcleritis, uveitis, retinal haemorrhages, and oedema (local or general). Episcleritis has only been noted once before (Zohman and Silverman, 1942). A further case is reported below, together with another presenting with subconjunctival haemorrhage, of which I have been able to find no previous example. Case Reports Case 1, a girl aged 11, was admitted to hospital on October 31, 1955, complaining of a sore throat for 5 wks, and swelling of the left eye for 18 hrs. Examination.-Temperature 99.20, pulse 132, respiration 24. She looked ill and pale. A large subconjunctival haemorrhage was present in left eye, and a membrane was seen on the left tonsil and post-pharyngeal wall. Multiple neck glands and the spleen were palpable. Laboratory Investigations.-White cell count 20,000, mononuclears 80 per cent. The result of the Paul Bunnell test was 1: 1280 on admission and 1: 160 after absorption. Treatment.-Oxytetracycline 1 g. daily was given for 5 days. Progress.-The throat cleared in 2 days and the subconjunctival haemorrhage in 10 days. The patient was discharged as recovered on November 11, 1955.