Your Eyes and Hepatitis B

Complications That Can Affect Your Eyes

A Depiction of The Hepatitis Virus. Credit: MEHAU KULYK/SCIENCE PHOTO LIBRARY

Hepatitis B virus (HBV) is the most common cause of liver cancer. The virus infects liver cells, eventually causing liver failure. HBV is transmitted through sexual contact, needle sharing, blood transfusion and passage from mother to child during birth. One can also develop non-infectious Hepatitis from excessive alcohol or medication use. When someone becomes infected by HBV they may experience fatigue, fever, loss of appetite, vomiting and jaundice.

Many people aren't aware of the eye problems and complications associated with HBV infection. Following are three HBV complications that can affect your eyes.

Retinal Vasculitis 

Vasculitis refers to inflammation of the blood vessels. This inflammation is the result of debris left over from a foreign invasion by either a virus or bacterium. When HBV causes an infection, it leaves debris in the blood vessels. The body creates an immune response to clear it out of the body. Sometimes this vasculitis occurs inside the eye, affecting the retina. Reduced blood flow causes white spots to develop in the retina called cotton wool spots. Cotton wool spots represent areas of ischemia, or a lack of adequate blood flow and oxygen to the retinal tissues.

Third Nerve Palsy 

HBV infection can cause temporary paralysis of the third cranial nerve that controls eye muscle movement. The third cranial nerve, also called the oculomotor nerve, is a nerve that originates in the brain and has a fairly long pathway in the body.

This nerve is partially responsible for eye movement and changes in the size of our pupils. Some third nerve palsies can involve the pupil and are much more dangerous. If a third nerve palsy is suspected, you must see an eye doctor immediately and possibly a neuro-ophthalmologist, especially if you notice changes in your pupil size.

 A third nerve palsy, although rare, can be caused by an aneurysm. Typically, HBV can cause a third nerve palsy without affecting the pupil. This occurs in HBV infection because of the accumulation of immune system components that produce a lack of blood flow to the third nerve causing paralysis of the nerve.

Optic Neuritis and Uveitis 

Optic neuritis is an acute inflammatory condition of the optic nerve, the nerve cable that connects the eye to the brain. Uveitis is an inflammatory condition that affects the tissue in the front part of the eye.  These conditions are thought to be caused by antibodies and free-flowing immune system debris brought about by the HBV infection.

Interestingly, patients being treated for hepatitis can develop side effects from the treatment itself, possibly affecting eyesight. One drug used to treat hepatitis is called Interferon. Interferon is a chemical mediator that brings certain white blood cells to the damaged tissue to decrease viral replication. Interferon can have side effects such as headache, muscle pain, hair loss and fatigue.

It can also cause eye complications in the form of retinopathy. The retina may develop cotton wool spots, blood vessel abnormalities and hemorrhages. Patients that are placed on Interferon therapy should have frequent visits to the eye doctor when they are treated with this medication. Interferon can also cause the following conditions:

  • Subconjunctival hemorrhages (broken blood vessels on the white part of the eye)
  • retinal detachment
  • optic neuropathy
  • increased eye pressure

Although most patients do well while taking Interferon, Interferon-induced eye problems usually show up two weeks to six months after Interferon treatment begins.


Source: What are the ocular manifestations of Hep B?  Review of Optometry, 15 March 15, 2014, pp60-64.

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