This peculiar kind of eye infection unique to Nepal is very dangerous and any delay in treatment can lead to blindness. “The disease is extremely dangerous and can harm the eyes within hours,” says Medical Director at Tilganga Institute of Ophthalmology Dr Sanduk Ruit.
- Eye becomes red as in conjunctivitis but without sticky secretion
- Patients have difficulty in even opening the eyes in light and white spot appears in black part of eye
- Can lead to blindness if not treated within 48 hours
- Is believed to be caused by contact with white tussock moth
- Children should not be allowed to go near this nocturnal moth that is attracted to bright light and even adults should stay away
This disease has been reported only in Nepal and it has many peculiarities. “It is reported every two years (odd year in Gregorian calendar and even year in Nepali calendar) from September to December and infects only one eye, mostly the right eye,” says Dr Anu Manandhar, uveitis specialist at Tilganga.
Records show six SHAPU patients had come to Tilganga in 2005 and 18 in 2007. But this year the number has already gone up to 24 since the first case was seen on August 23.
The disease, first seen in 1975 and named SHAPU by Dr Madan Prasad Upadhyaya, used to be reported initially from Kaski district but has now spread to various other districts. Majority of the patients this year are from Dolakha district while others are from Sarlahi, Rolpa and Dailekh. Three patients this year are from within Kathmandu Valley. Nepal Eye Hospital, Tripureshwar has also reported six SHAPU cases in the past few weeks.
“The fluid used to show bacteria previously but in 2005 and 2007 we also found virus. This year also both bacteria and virus have been found in the eyes of the patients,” states Dr Manandhar.
Cause of the disease
The cause of the disease is yet to be confirmed but doctors believe the white tussock moth is responsible. “Most of the cases this year and even previous years have shown a history of moth contact or moths in the environment. We have even found hairs of the moth in the eyes of a few patients this year,” Dr Manandhar says.
Most of the infected patients this year are below 10 years with the youngest being 11 months. One patient is a 66-year-old. “We feel that children who tend to play with this moth get infected,” Dr Manandhar reasons.
The nocturnal moth can be seen around bright lights and doctors suggest that people beware of such white moths and prevent children from playing with them. These moths do not fly, but only crawl.
The infected eye becomes red as in conjunctivitis but without sticky secretion, the eyesight gradually becomes weaker, patients have difficulty in even opening the eyes in light, and a white spot is seen in the black part of the eye due to accumulation of pus.
“It can be treated through antibiotics and antivirals in the initial stages but needs surgery in the later stages. We should perform the operation within 48 hours and remove the liquid to save eyesight,” says Dr Rohit Saiju, consultant ophthalmologist at Tilganga. Eleven out of the 24 patients this year have been operated on at Tilganga.
Dr Saiju says that doctors initially mistook the disease for retinoblastoma, a kind of cancer in which the eyes become white, but later found it to be a new disease.
Doctors don´t have any explanation for the biennial occurrence of this disease. “It may be related to the lifecycle of the moth or due to other reasons. We will seek outside help including that of entomologists to determine the cause of the disease,” Dr Saiju said.
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