Ebola Survivors Likely to Experience Ocular Symptoms

Survivors had higher color vision deficit, lower IOP, and more cases of uveitis than controls.

Survivors of Ebola virus disease (EVD) experience a spectrum of ocular symptoms in the years after obtaining antibodies, according to findings published in JAMA Network Open.

In this cross-sectional analysis conducted in Liberia, West Africa, researchers compared the ophthalmologic examination data, symptoms, and tomography images of survivors of EVD who tested positive for IgG antibodies and their antibody-negative close contacts. They found that the 2 groups showed disparities. Patients who had recovered from EVD had higher color vision deficit, lower intraocular pressure (IOP), higher percentage of vitreous cells and macular scars, and more cases of uveitis. 

“Close contacts were defined as household members, friends, or neighbors of survivors at the time of diagnosis or after recovery from EVD and sexual partners of the survivors after discharge from the treatment facility,” the study explains.

This analysis, in which 564 survivors and 635 close contacts participated, took place within a larger longitudinal cohort study, the Partnership for Research on Ebola Vaccines in Liberia III: Ebola Natural History Study (PREVAIL III, ClinicalTrials.gov Identifier: NCT02431923), which followed survivors for 5 years. Prior research has found that many EVD survivors who seek care after the resolution of the disease present ophthalmic sequelae.

The study explains, “Ocular symptoms can occur as part of the initial presentation of EVD or after resolution of the systemic illness.”

During the analysis of symptoms at the time of their examination, survivors reported trouble seeing (49.1% vs 36.1%), sensitivity to light (49.1% vs 40.1%), and eye redness (25.6% vs 18.4%) at a higher rate than their close contacts. Furthermore, 26.4% of survivors had uveitis compared with 12.1% of close contacts.

Though the research showed a higher rate of ocular symptoms among survivors, the researchers acknowledge the need for a comparison group because a high percentage of close contacts also showed the same signs. Researchers also identify as a limit the fact that participants may have been motivated to take part in the study due to limited local eye care services. Finally, the researchers say that the window of analysis of the cohort, which was from June 2015 to March 2016, may be considered a limit because of its short time span. 

They conclude that the extent to which survivors of EVD experienced sequelae is significant enough to involve more than just ophthalmic pathology.

“Together, these signs point to multifaceted visual deficits that may involve pathology distributed throughout the central nervous system,” the study explains.

Disclosure: One study authors declared affiliations with the biotech or pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Eghrari AO, Bishop RJ, Ross RD, et al. Characterization of Ebola virus-associated eye disease. JAMA Netw Open. 2021;4(1):e2032216. doi:10.1001/jamanetworkopen.2020.32216.