Patterns of Ocular Involvement and Associated Factors in Adult Measles: A Retrospective Study from a Romanian Tertiary Hospital

TL;DR

This study found that most hospitalized adults with measles in Romania had eye problems, especially keratitis, linked to higher inflammation levels.

Contribution

The study provides new insights into the frequency and inflammatory correlates of ocular involvement in adult measles cases.

Findings

93.2% of patients referred for eye exams had ocular lesions, with keratitis being the most common.

Patients with keratitis showed higher neutrophil-to-lymphocyte ratios, indicating stronger inflammation.

Inflammatory markers were more strongly linked to respiratory failure than to ocular involvement.

Abstract

Background: Measles re-emergence has been reported across Europe, with Romania being among the most affected countries in 2023–2024. Although ocular manifestations are recognized in measles, their frequency and inflammatory correlates in hospitalized adults have not been well characterized. Methods: This study retrospectively analyzed the medical records of adults treated for laboratory-confirmed measles at a Bucharest hospital between July 2023 and July 2024. Data from specialist eye examinations were used to compare patients with keratitis against those with other ocular issues. Results: A total of 250 adult patients were included. Of the 88 patients referred for ophthalmologic examination, 93.2% showed ocular lesions. Keratitis was the primary form, identified in 64.6% of these cases. Patients with keratitis had blood markers indicating a more activated inflammatory profile (higher neutrophile-to-lymphocytes ratio). Pneumonia and respiratory failure were not associated with ocular lesion status; inflammatory markers were more strongly linked to respiratory failure than to ocular involvement. Conclusions: Ocular lesions were highly prevalent in hospitalized adult measles cases during the 2023–2024 Romanian epidemic wave, and keratitis was common. Ocular involvement correlated with mucosal disease expression and systemic inflammatory activation. Systematic ophthalmologic assessment should be considered during measles epidemic peaks to improve early identification of clinically relevant ocular complications.

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