U.S. physician Ian Crozier was declared free of Ebola in October of last year, but a new report in JAMA reveals how the deadly virus stuck around in his eye, causing vision loss and changing his eye color.
New symptoms after surviving Ebola
Crozier contracted Ebola while volunteering with the World Health Organization in Sierra Leone to fight the deadly outbreak. The disease nearly killed him, but in October he left Emory University Hospital in Atlanta symptom free and with no trace of the virus in his blood.
Less than two months after leaving the hospital, Crozier was back with intense pain and pressure in his left eye. He was also steadily losing his sight. Doctors determined Crozier was afflicted by uveitis, a dangerous internal inflammation of the eye.
Initially, doctors assumed Ebola had worn down Crozier's immune system, leaving him vulnerable to another type of virus. The surface and tears of his eye were Ebola-free. Doctors decided to draw a small amount of fluid from inside the eye in order to determine if he should be given an antiviral drug.
Steven Yeh, an ophthalmologist, performed the procedure. When the lab result came back doctors were shocked; Crozier's left eye was full of the Ebola virus.
While there have been several recorded cases of uveitis in survivors of previous Ebola outbreaks, the condition was thought to be rare. However, doctors in West Africa are beginning to report more instances of the condition. It is an example of just how little experts know about the long-term health implication of surviving Ebola.
Experts examined Crozier's treatment and explored possible reasons why Ebola could have remained in his eye. They note that the eye is largely protected from the body's immune system in order to protect it from inflammation which could damage sight. The testes are similarly protected, which is one of the reasons experts think Ebola can linger in semen.
While the exact mechanism through which Ebola infects the eye is not known, Crozier's diagnosis presented more immediate challenges. For one, Yeh had not worn adequate protection when he drew fluid from the eye. Immediately, doctors made sure no other people had used the exam room and disinfected it thoroughly. Yeh took his own precautions, deciding to sleep in his guest bedroom and avoid contact with his infant son for three weeks.
In the meantime, Crozier's sight continued to worsen. Ten days after symptoms appeared his eye became soft to the touch. "The eye felt dead to me," Crozier says. It had also changed color, shifting from bright blue to green.
Doctors were not sure if the damage to the eye was the result of the virus itself or inflammation caused by the body's immune response. Treating the inflammation with steroids could have the unintended effect of making the infection worse, but there are no antiviral drugs known to work against Ebola. "What if [the steroids] unleashed the virus?" Crozier wondered.
Doctors tried a high dose of the steroid prednisone. Crozier suffered from severe side effects, and his sight continued to decline. He was also beginning to lose hearing in his left ear.
An experimental gamble
With few good treatment options, Jay Varkey, an infectious disease doctor who had been coordinating Crozier's care, petitioned FDA for permission to try an experimental antiviral drug. The doctors have not disclosed the name of the drug, but say more details of the treatment will be published in a medical journal soon.
After a week on the medication, Crozier began to see faint outlines of family members in his hospital room. Over the next few months, his sight returned fully.
Varkey is not certain whether the experimental drug led to Crozier's improvement, but he hypothesizes it played a role. "I think the cure was Ian's own immune system," he says, explaining that the drug may have reduced symptoms enough for Crozier's own body to finish the job.
Crozier's recovery is only a first step in a much larger effort to understand and treat survivors of Ebola. With his sight returned, Crozier is already doing his part to help other survivors: On April 9, he left for Liberia with Yeh, his ophthalmologist, and several other Emory physicians to examine the eyes of other Ebola survivors (Grady, New York Times, 5/7; Shute, "Shots," NPR, 5/7; Bever/Moyer, Washington Post, 5/8; AP/USA Today, 5/8; Karimi/Berlinger, CNN, 5/8).
The takeaway: Experts say the long-term health implications of Ebola for survivors remain unclear.